Laserfiche WebLink
�� P�MIT APPLICATI� <br /> I, CITY EVERETT PERMIT SER ICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810 - FAX 425-257-8857 ' <br /> � -�'J-IY�--�� <br /> ��I �fE AD�RESS PARCEL TAX I.D.# aEaMi7 x KO60�'-00 <br /> I ,1-�� '� .' Z D t7 � D O - -O <br /> LEGA l0T N0. BLOCK TRACT <br /> I DESC. <br /> IOWNER ADORESS ZIP PHONE <br /> I (,��N<.�c_� �/Yc� Zi�'" 5�2t-� T�c� 9fs42-� <br /> �I TENANT NAME CONTACT NAME PHONE <br /> l�E"'.\1��� � � � �� .\ 0�L�.� 'L_)h �/�-�!�Li <br /> C,O�NTRACTOR ADORESS C 21P CONTR.LICENSE R � <br /> ( ��t�V^,'�-r }=.Ac �YG`�`l�'(.fik-Y1,�11L- �1U� 113� �1i�- l� C � <br /> PHONE I L�L CJI�Y�J. � V�J� � ��i�C�- � <br /> ��`�L���a���� <br /> �`;��- <1 �t o- 3:.'�'=i `, <br /> j PNOPOSED USE OF BUILOING BUilding I-1 MBChaniCal Addition HEAT SOUHCE <br /> � PERMIT R Combination �� Plumbing WORK � Alteration n Electric <br /> � TYPE � Demolition IJ Sign TYPE New F� Gas <br /> I �;.�k.`�,�, p� Sprinkler RepaidMainL LJ Other <br /> ICO�lTRACT PRICE Oi WORK CYTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � <br /> ` l�� ��Wl,'L-�`� {�:�i \�i1N iti����S "'� 1C�1�1� S <br /> � " (;l.a'C� ��:1(,t`� 'U(`�IC^X \�J--�� �a 1C�'� CI�V� <br /> � � ,� V �v� G'�CG�S � <br /> I PLUMBING MECHANICAL � <br /> NO. TVPE OF FIXTURE OR ITEM NO. TVPE OF FUfTUHE OA iTEM � <br /> � WATER CLOSET A/C—A/HANDLING UNITS <br /> ' BATHTUB FORCED AIR SYSTEMS <br /> ! LAVATORY(WASH BASIN) HEAT PUMP <br /> ' SHOWER UNIT HEATERS � <br /> '.. KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> ��. DISHWASHER RANGE HOOD <br /> �, LAUNDRY TRAY WATER HEATER � <br /> �. CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING rOUNTAIN . GAS FIREPLACE <br /> FLOOF DRAM � GAS RANGE <br /> BACKFLOW PREVENTER GAS FIPING <br /> SINK (SERVICE/BAWMOP/ETC.) . EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE ANO CORRECT. AlL � <br /> PPOVISIONS OF LAWS AN�ORID!NACES GOVERNING THIS TYPE OF WORK WILL EE COMPUED WITH WHETHEF SPECIFIED HEREIN OR <br /> NOT. THE GRAN7ING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PfiOVI,SION OF ANY OTHER � <br /> STATE OR LOCAL LAW REGUTATiNG CONSTPUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORlZED 0Y THE � <br /> OWNEF Of THIS PROPEFTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br /> �9ACTORS LAW 1827 FCW AND 296200 WAC. <br /> / ! � ,y <br /> l_ -�-�i!R / I' .( A '��,a ��,—� r ,� � � <br /> Signawre of e o a t NA�t or ed Agent � Dat� <br /> �Z <br />