Laserfiche WebLink
wERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 C— FAX 425-257-8857 <br /> SITE ADDRESS PApCEL TAX I.D.p PEFMIT x <br /> � � - Co i- ' ,c', o i3 c9oa c�8 0o C�3D3 -oD <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> �� G 7 �'� r � �i-� /J /1, �=v �r C�J� �-r/i9 ��72 o y <br /> TENANT NAME � CONTACT NAME PHONE <br /> �� Q�'� G. �� O ' �)Y <br /> CONTRACTOR ADDRESS <br /> /1 ZIP CONTR.LICENSE M /7 <br /> rHONE Z � L �( C �J��f�3�J <br /> /,2 / /-a g i�I, �,� �3s9 <br /> PROPOSED USE OF BUIL�ING BUilding Mechanical Addi ion HEAT SOURCE <br /> PERMIT R Combinalion R Plumbing WORK Alteration Q Electric <br /> S�/' TYPE Demolition � Sign IYPE New �j Gas <br /> j /�— B Sprinkler Repeir/MaIN. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT I.00AL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION /'� . <br /> ��`a� ���� 7�"- C'G�l a� c,�oC�.�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYp=OF flXTURE OR REM <br /> _ WATER CLOSET _ A/C—A/HANDIING UNITS <br /> _ BATHTUB _ FOFCED AIR SYSTEMS <br /> _ LAVATORY(WASH BAS!N) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DI&POSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <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 /> i _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> I _ OTH�R _ OTHER <br /> I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFCT. ALL <br /> PROVIS�ONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> t�OT. THE GqANTING OF A PERMIT DOES NOT PRESUMt TO GIVE AUTHORIN 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 WORI<FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � � f -=�-i� .� �/O - O � F'o '3o3 -0�1 <br /> Signature of OwneqContract U uthonzed Agent Date <br /> � UEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />