Laserfiche WebLink
PE�MIT APPLICATIOiV <br /> CITY OF EVERETT PERMIT SERVIC�S (, <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G ' �6 � 7 <br /> 425-257-8810- FAX 425-257-8857 �+� �O� ' � <br /> SITE ADDRESS PARCEL TAX I.D.# PE MGIT/#�,�� <br /> J i � �� � ;�r' •=:r, n_f !I — G � S —Lc � / W/ � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � . , P//b'F �cz_�' - D I V, A <br /> OWNER ADDRESS 21P PHONE <br /> . I� ,� . � <br /> TENANTNAME CONTACTFORPERMIT PHONE I <br /> � " 7L� '� — �i— �O ' <br /> CON1T'RACTOR ADDRE55 ZIP CONTR.LICENSE# <br /> rtlCil� � C(�Gh� /-��'i71 �� i.LL'; 4'•'I7S 3�7�Lt �V>_ 5!_ `�$ZCLS hl�s',l�T�L`l7704 <br /> PHONE <br /> ���U� <br /> PROPOSED USE OF BUILDING ppprrrxxx��� Building f�Y Mechanical Addition � HEAT SOURCE I <br /> PERMIT �Combinalion �,�Plumbing WORK � Alleration I � Electric <br /> TYPE Demolilion IJ Sign TYPE New Gas <br /> Sprinkler Repair/MainL Other <br /> CONTRACT PRICE OF WORK �/ � C�G �„^�C.+ � CITY OF EVERETT LOCAL SAlES TAX CODE IS 3105 <br /> WORK DESCRIPTION (S i� ��.. �_� �!��;i�ti p U���1.��.n <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 7 FORCED AIR SYSTEMS <br /> , �L LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> y KITCHEN SWK&DISPOSAL � CLOTHES DRYER <br /> DISHWASHER _� RANGE HOOD <br /> _:%� LAUNDRY TRAY _Z WATER HEATER <br /> _� CLOTHES WASHER 1` METAL FIREPLACE/STOVE <br /> r URINAL � FIREPLACE INSERT <br /> � DRINKING FOUNTAIN � GAS FIREPLACE <br /> .. FLOOR DRAIN �_ GAS RANGE <br /> =. BACKFLOW PREVENTER `� GAS PIPING N- � <br /> c SINK(SERVICE/BAR/MOP/ETC.) �� EXHAUST FAN <br /> 1- OTHER OTHER_ <br /> I <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL II <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF Y1'ORK WILL BE COMPLIED\NITH WHETHER SPECIFIED HEREIN OR I <br /> i NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUAfE TO GIVE AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISION OP ANY OTHER <br /> ISTATE OR LOCAL LAW REGUL.ATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> IOWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE �, <br /> CONTRACTORS LAW 18.27 RC�D 296.200 WAC. <br /> � G -� -c+ � <br /> Signawre o Own dContractodAuthcrized Agent Date w ��5��5 <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � y�2 � <br />