Laserfiche WebLink
�EF�MIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRES PARCEL TAX I.D.# P RMIT# <br /> I�4-I. 1`�rm c�cQc..�cu 1.�303�o -o c 7 <br /> LEGA LOT NO. BLOCK TRACT � ^ `� _ / / � <br /> �ESC. C7V UItY <br /> OWNER ADDRESS 21 PHONE <br /> � �'"1 b(-2r�,� i �1 � I� ��'p�. - <br /> ANTNAME NTACTFORPERMIi o Pf10NE <br /> C� ��C C`�--c�.� ��;. i— I �1�s �� 1� �-� �.c ` � ' � � �2 - � , <br /> CONTRACTOR ADDRESS NTR.LICENSE# <br /> PHONE , 10 ti�r�� � � <br /> v��� u.� i <br /> PROPOSED USE OF BUILDING Building Mechanical Additlon HEAT SOURCE <br /> I PERMIT � Combination R Plumbing WORK R Alteration � Electnc <br /> TYPE Demolition � Sign TYPE New Gas <br /> Sprinkler � Repair/Maint. I Other <br /> CONTRACT PRICE OF WORK _ �L> �� CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> �J <br /> WORK DESCRIPTION � • <br /> 1 <br /> � 2 x 10 ��f3Rec,�4s5 �ou r� ov�rL � MPS•i C(� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWR.SHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING I <br /> SINK(SERVICEIBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER 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 LP.WS 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 REGUTATING 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 296200 WAC. <br /> Signalura o(OwnedContracrodAulhonzed Agenl Date ,� <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />