Laserfiche WebLink
i <br /> ! , ERMIT APPLICAl . JN � <br /> � CITY JF EVERFTi" �E�tMIT SERVICES � <br /> � <br /> I 3200 CEDAR STRi_CT, EVERETT, WA 98201 I <br /> 425-257-8810 - FAX 425-257-8857 i <br /> i <br /> SITE ADORESS PARCEL TAX I.D. # PERreIT s <br /> h�oo 5.f.E-����:E1T M.q4� WAY-SuirE �le2 /F12� �53 05y Uv o� I��G`�. —G�� I <br /> LEv"A LOTNO. BLOCI( TRACT I <br /> CFSC. I <br /> on.. ta✓�k. s//E�T <br /> OWNER �DRESS � ZIp PHONE <br /> � d n/ Bni���„i ST t✓iTE SSOU SL:A171�W�' <br /> ✓✓��6 MiT/��P✓ <oc����zs iiv�EKn�anc��� 9�ioi y25-3i5- �6'a� � <br /> TENANTNAME CONTAC'fNAME pHONE <br /> , r j��c- �p�M Df�l.c��MENT�c�nsT I L/+✓/D /�0/zTf.R ��ZS-3�i'J-(,�9i� I <br /> :CONTRACTOR ' I � � • ADDRESS Z1P CONTR.LICENSE# <br /> /!�� � ���'LL.C�L������Y� <br /> ' PHor+e / <br /> - �—�! i ZO/ -5�3� -�9�Gz <br /> PROPQSeu USE OF BUILDING Building Mer,hanical Addition HEAT SOURCE � <br /> � PERMIT Combinalion Plumbing WORK Alleration Electric I <br /> OFF/CE �F'/ic E <br /> I TYPE Demolition Sign TYpE � New � Gas <br /> �oM/JJEK'U/�L-- Sprinkler U RepairlPdaint. Olher <br /> � <br /> CONTRACT PRICE OF WORK q� ,8 n�,J L�� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> f�- <br /> WORK DESCRIPTION <br /> � NFw p�nl��ir✓,� �NAL!-� Tf-r✓f3NT WALG.S, �o�a.S Tw� �E��TcS ,�E�o�Ar �i�,`/ri,✓� <br /> i f��71� Nc'v� �tn��r�/�iid�,f F�c���'i��� ouT�ET.S <br /> � <br /> PLUMBING MECHANICAL <br /> i NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> �. _ WATER CLOSET A/C —A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HGATERS <br /> _ KITCHEN SINK & DISPOSAL = CLOTHES DRYER I <br /> _ DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> CLOT:iES WASHER METAL FIREPLACE/STOVE <br /> URIf�AL FIREPLACE INSERT <br /> _ DPINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BAPoMCP/ETC.) EXHAUST FAN I <br /> _ OTHER _, OTHER I <br /> � <br /> - I <br /> I <br /> � I HEREB'1 CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW lHE SAME TO BE TRUE AND CORRECT. ALL <br /> � PRGVISIGNS CF 111W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEqFI[D HEREIN GR <br /> I NOT. THE GR„IJTING OF A PERMIT�OES NUT PRESUIdE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE?ROVISION OF ANY OTHER � <br /> S7ATE OR LOCAL LAW REGUL;ITING COP75TRUC iION OR THG PERFORPAANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE � <br /> OIVNER OF THIS?qCPERTf TO P[RFORM THE WORK FOR WHICH APPLICATION IS�.1ADE AND I COMPLY V✓ITH THE STATE i <br /> CONTRACTORS LAW 1�27 RC'�N AND 29G.200 WAC. <br /> � � / � <br /> /'.f!l./�;� i�-�/'�� i <br /> SignaWre o� CwnevContractodAulhorized Agen� ' Date �/ <br /> d <br /> — i <br />