Laserfiche WebLink
PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS _ <br />PARCEL TAX I.D. # <br />PERMIT # <br />13a s <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />W ewde, Saaz'f D e u , ,-Z;vc-, I`►y r 40 k Aio,6 d'Z v/mod //ee , ram. 0 b zqs- <br />TENANT NAME <br />CONTACT NAME PHONE <br />�+ ^� <br />,y,� <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />Rr Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT Combination IIL--(I( Plumbing <br />WORK <br />Alteration <br />Electric <br />TYPE Demolition Sign <br />TYPE <br />New <br />Gas <br />/J sic, os <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK / �/% <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION 34,si �, <br />! <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />& <br />A/C — A/HANDLING UNITS <br />I� <br />BATHTUB I <br />I <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) f' IU <br />HEAT PUMP <br />of <br />SHOWER / / <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />P <br />CLOTHES DRYER <br />DISHWASHER <br />—% <br />RANGE HOOD <br />45: <br />LAUNDRY TRAY <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />�1 <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />T <br />GAS FIREPLACE <br />FLOOR DRAIN <br />/ <br />GAS RANGE <br />BACKFLOW PREVENTER <br />�_ <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />I <br />OTHER <br />OTHER <br />} I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />i OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />i <br />I <br />