Laserfiche WebLink
PERMIT APPLICA�ION <br />CITY OF EVERETT PEaMtT SERVICES <br />3200 CEDAR STREET, EVERETT, V✓A 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE pD� ES� , \ <br />1� � �J <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />_ � �.�,���ov� <br />TENANT NAME <br />CONTpACTOR <br />PHONE <br />PROPUSED USE OF BU�LDINO <br />PERMIT <br />TYPE <br />CONTRACT PRICE O!' WORK <br />WOqK DESCRI ,JN <br />C�l��-/ JCLN' i <br />�L�1N�91L�a <br />N0. � TVPE OF FI%TURE OR ITEM <br />� WATER CLOSET <br />__ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />_ CLOTHES WASHER <br />_ URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />UACKFLOW PREVENTER <br />� SINK (SERVICE/BAR/MOP/ETC.) <br />__ OTHER <br />— �— <br />PARCEL TAIf I.D. / <br />CONTAC7NAME <br />ADDRESS <br />I� Bulldinp <br />D Combinetlon <br />BDemolltlon <br />Sprinklar <br />PHONE <br />PHONE <br />CONTR. LICENSE � <br />C Mechenical Additbn HEAT 80URCE <br />BPlumbing WORK R Alte�atlan (7 Electrk <br />Slgn TYPE � New D oey <br />Repelr/Maint. � O�her <br />CITY OF EVERETT LOCAL SALE9 TAX CODE IS 3105 <br />�i�e � ..� �� �� <br />%' �%' C� <br />J <br />NO. � TYPE OF fl1(TURE OR REM <br />A/C – A/HANDLINO UNI7S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANOE HOOD <br />WATER HEATEH <br />METAL FIREPLACE/6TOVE <br />FIREPLACE INSERT <br />OAS FIREPLACE <br />OAS HANOE <br />l3AS PIPINp <br />EXHAUSTFAN <br />OTHER <br />I HEFiEBY CERITI�Y THAT I HAVE READ AND El(AMINED THIS APPIICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES 60VEPNIN6 THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. iNE GRAN71N0 OF A PERMIT DOES NOT PRESUME TO pIVE AUTHORITV TO VIOUTE OR CANCEL THE PROVISION OF ANY OTHER <br />ST TE OR LOCAL LAW REOULATIN6 COIJSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIIED BY THE <br />O ER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CO RACTORS LA�pCW AND 296.200 WAC. �� I <br />SVIi� _ �u1 <br />