Laserfiche WebLink
� t` <br /> PERMIT �4PPLICATION ; <br /> CITY OF EVERETT PERMIT SERVICES + <br /> 5200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS G��°"'T Purra PARCEL TAX I.D.# PERMIT u <br /> '� S EVc-iZC,�z�-�1 w y�dZ-oo�_��l -o��' SD�-P�I-GOcI <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER p ADDRESS / ZIP PHONE <br /> P� i A-G( rl� �./Zoo!:�'I��S a�'c7��fi/b�¢/`I"✓� � �1 S3� 1lS`i' 3a j o <br /> TENANT NAME CONTACT NAME ��'�,,.^L rl��� PHONE <br /> S� 2 rP�-vy � y <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> �Q�I S!(�1 SG�✓[CcS ��212 �ol�{�-l-C_ W� SE �i (�S/5'�99o�n1 <br /> PHONE � t I1.1� Ge-C��L w� °/ ��1 Z <br /> y2s)33�-8Y6� '�/'� �. � N i <br /> PROPOSED USE OF BUILDING j� 8uiiding Mechanical Addition HEAT SOURCE <br /> PENMIT �} Combination � Plurtlbi�g WORK R Alleratlon D Electric <br /> TYPE Demolition Sign 7YPE R New D Gas <br /> �Er1�-► l. B Sprinkler LJ RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK ��b�� CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> N�ORK DESCRIPTION <br /> �nJs'C�'���.- on1� s� or c.c�'T'�-lZs n�r.�o 1�oC�o . <br /> PLUMBING MECHANICAL <br /> P70. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <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 HEAI'ER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE � <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN � _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) ,_ EXH�UST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CURRECT. ALL <br /> PROVISIONS OF LAWf'i AND ORIDINACES GOVERNIfJG THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEPEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESU!dE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR�OCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROFERTY?O PERFORM 1'HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC LAW'18 2;RCW AND 296.200 WPC. / <br /> �, j/�c�/0 Z� <br /> Signal �of Owne�;ContraclodAuthonzed Agent � Date �I <br />