Laserfiche WebLink
PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9U201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � o i fo-ac,5 <br /> SITE ADDRESS ' PAHCEL TAX I.D.A PERMIT M <br /> Z 11 P v a c�w A '►��'°$`$O� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> X �t eSS Lc, ►� � <br /> TENANTNAME CONTACTNAME PHONE <br /> , , I � � O - LO � <br /> CONTRACTUR ADORESS ZIP CONTR.LICENSE N <br /> PHONE 3� . L(,jrS'C�p� <br /> PROPOSEDUSEOFBUILDING Building n MeChaniCel Additlon HEATSOURCE <br /> PERMIT R COmbinelian K�Plumbing WORK �Ileretion (� Electric <br /> TYPE D Demolition LJ Sign TYPE New � Gas <br /> U Sprinkler Repair/Meint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> WOPK DESCRIPTION <br /> `i�,✓D �cSE �jpw�,r 1✓t tilec.J �u t l�� n C�. <br /> ' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> 2 WATERCLOSET A/C—A/HANDLINGUNITS <br /> 6ATIiTUO FOFiCED AIR SYSTEMS <br /> ?L LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATEfiS <br /> KITCHEN SINK fS DISPOSAL CLOTHES DRYER <br /> DISHWASIiER RANGE HOO� <br /> LAUNDRY TRAY � W�TER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FUUNTAIN dAS FIREPLACE <br /> FLOOR DRP�IN GAS RANGE <br /> BACKFLOVJ PR[VENTER GAS PIPING <br /> SINK(SEFlVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> �, — — <br /> I IIEREDY CERITIFY THAT 1 HAVE REAO AND EXAMINED TIiIS APPLICATION AND NNOW THE SAME TO�E TRUE AND CORRECT. ALL <br /> PROVISIONS OF l.AWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL OE COMPLIED WITH WfiETHER SPECIfIED HEREIN OR <br /> NOT. TI1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTIIORITY TO VIOLl�TE OR CANCEI THE PROVISION OF ANY 0TI1ER <br /> STATE OR LOCAL LAW REGULATItJG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TI1AT I AM�UTHORIZED BY TfiE <br /> OWNBR OF 1HIS PROPERTY TO PERFORM THE WORI(FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> COWTRAC�RS LAW 18.27 RCW AND 296200 WAC. <br /> /`�P� � �fil� S /D- 2 3 �b� <br /> Signa ure ol OwneUContrac�uthorized Agent Date � <br />. <br />