Laserfiche WebLink
P�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />��..% l.�la �►� <br />SITE ADDRESS PARCEL TAX I.D. # P�E�MIT # <br />� <br />��.�� � f�.�- „�s � �� ti � �� � , . � ^ �� �. � 7�0 ��.� C.f�/C��:�.� <br />LEGAL LOT NO. BLOCK TR2ACT <br />DESC. ' a.7 � �:J�.�-�k;1�i-j-1 �� � lIS � , <br />OWNER ADDRESS ' ZIP PHONE <br />�? ��. �. l�Ci.. � VZ��- ��\S�`� t.-�-�- ('%O '� �'�JS��A U`:� S� l'�a���- �t55r�✓ la� 1� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />� I ' -� � �---���5�� �-t�� -, � � - � �c I � <br />. <br />CONTRACTOf� ADDRESS �' ZIP �C,�ONTR.LICENS�# <br />� � �: �,�. � ���.�%�E P.�s�s �L�..� ° �1 �`�-�� �`'�` a�:� sF t��� q�s�-r-�-- <br />PHONE ' �.�Fy IR�=.�'�= �J��i <br />���3%� ' : <br />PROPOSED USE OF BUILDING <br />� ����� �-_����� <br />����s� c�L�.�— <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�! e,� � L4�..,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />:� WATER CLOSET (TOILET) <br />� BATHTUB <br />_t� LAVATORY (WASH BASIN) <br />� SHOWER <br />�_ KITCHEN SINK & DISPOSAL <br />�_ DISHWASHER <br />LAUNDRY TRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />uilding Mechanical Addition HEAT SOURCE <br />PERMIT Combination �lumbing WORK Alteration Electric <br />TYPE Demolition Sign TYPE ew � Gas <br />Sprinkler RepairlMaint. U Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I---A K e 1 cv.�.t;� ������� l 3 i <br />�aiLXy'J��►1[•�_l• <br />NO. I NPE OF FIXTURE OR ITEM <br />�_ <br />—� <br />�— <br />� <br />A/C—A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <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 />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />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 />Sign <br />ntrad�or/Authorize� Agent �ate <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED %� C-' ��� y-',�_ <br />