Laserfiche WebLink
—� <br /> R �RMIT APP�.ICHTI�. N ( <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 CEDAR STRE�T, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 � <br /> SITEADDRESS $OZS FL�I�IDf� DIZ • I PARCELTAXI.D.# PERMI7a <br /> �v�r i 1nFq g��e31 3q 3q _ on�7 _� �� _ o 0o c� I C� �� -ooS <br /> LEGA LOT N0. BLOCK TRACT �V��y P�1-RI� <br /> DESC. Z� � <br /> OWNER A�DRESS ZIP PHONE <br /> M A-n� �I u^f N+t �0�8 i=t.e tti� ��. (4-2�3S5=zB I <br /> �vt�T r� w� �l 8 2��, <br /> TENANTNAME Iv/� I CONT�T�N�AMi��N* �T�M)`ly /yq �4�3�-�IB <br /> CONTRACTOFI ADORESS ZIP CONTR.LICENSE M <br /> O�iNG�- , <br /> PHONE �j, .,y�) 355-2g1 � <br /> �r <br /> PROPOSED USE OF BUILDING �uildin e hanica Addition HEAT SOURCE <br /> PERMIT RI-( Com ination RI-( lumbin WORK A eration lectric <br /> � � � TYPE �] Demolilion U Sign TYPE Naw Gas <br /> U Sprinkle� Repair/Maint. �� <br /> CONTRACT PRICE OP WORK �7��� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK�ESCRIPTION ��TION EXlSTlN�T" M�I✓IX RD�% �p �r���� �NG /L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET _ A/C-NHANDLING UNITS <br /> BATHTUB _ FORCED AIH SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUAAP <br /> SHOWER _ UNIT HEATERS <br /> S� KITCHEN SINK& DISPOSAL CLOTHES GRYER <br /> ��_ DISHWASHER 1 -�_ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> 1� CLOTHES WASHER FIREPLACE NSERTSTOV� <br /> DRINKING FOUNTAW 2.,� GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER f.�_ GAS PIPING <br /> SINK (SERVICElBAR/MOP/ETC.) � �_ EXHAUST FAN <br /> , _ OTHER _ OTHER <br /> I — i —I <br /> I HEPEBY CEFITIFY THAT I HAVE AEAD AND EXAMINED THIS APPLICATIUN AND KNGW 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 /> INOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PPOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEP OF THIS?ROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> s �l G Z-- ��� .�1'�' � � � <br /> -.�u���N�,'��' 9 <br /> Signature of OwnerlConlractor/Authorized Agent Da �� <br />