Laserfiche WebLink
PE ZMIT APPLICATIO <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982.01 <br />425-257.8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. If <br />�QO <br />QC7 LA <br />J �pc/df DZ -00 <br />— <br />LEGA LOT NO. � OCK !O �! RACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />� <br />(wz �� Li/er� Pe k -' r W ��� <br />TENANT NAME �a G/L,� CONTA NAME PH E <br />�/ / <br />of I\C 1t �.I` / 12 �l j 3-73 -- P50 L <br />CONTRACTORA �s GU�(`-/�RES �2 J ZIP �CONT'CENSEk <br />(c <br />PHONE <br />PROPOSED USE OF BUILDING <br />/ <br />�pERMIT <br />Building Mec'ianical <br />Addition <br />R <br />I HEAT SOURCE <br />n <br />noR-/"z`,'A <br />1""��� <br />TYPE <br />COmbinalirn Plumbing <br />Demolition Sign <br />WORK <br />Alteration <br />B New <br />Electric <br />Gas <br />Sprinkler <br />(TYPE <br />RepairiMaint. <br />LfF-J(1 <br />Other <br />—T <br />CONTRACT PRICE OF WORK � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION // I �Q ' <br />Lz I7C� �`' //I G icce"y <br />yS/%%LL � �v�Q'C�1�(lAC� �(7-GI -rU <br />l �� e A T�11 e fi7gie <br />PLUMBING MECHA ICAL / J <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE 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 />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREFLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER _ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 LAWS 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 REGULATING 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 1827 RCW D 296.200 WAC. <br />2 -d <br />Signature of Owner/C ractor/Authorized Agent Date / <br />