Laserfiche WebLink
� 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> Oo 37 3 23 � �ll� -�r� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � oi�1��) - � <br /> L G L LOT NO. BLOCK TRACT <br /> DESC. �.�d�y 3� Z D !/�2P�7` /�/d J� <br /> OWNER ADDRESS PHONE <br /> /Gl ,�.�'�if���z � /%�P' �o�/�/� � -o2-s�U <br /> TENANTNHME I CONTACTNAME ( PHONE <br /> CONTRACTOR A /� /s�.,¢��S ADDRESS CONTR. LICENSE# <br /> �V � L/f STC.oe���tr,� <br /> PHONE /1.�5 ���—J�v76 Z- � ���� <br /> i . o i3ox .��v /,/�i7�6/d��a <br /> PROPOSED USE OF BUILDING wlding Mechanical Addition HEAT SOURCE <br /> PERMIT Combination R Plumbing WORK � Alteration D Elec�ric <br /> TYFE Demolilion p Sign TYPE tJew U Gas <br /> c <br /> �/'� � Sprinkler Repair/Maint. U ome� <br /> CONTRACT PRICE OF WORK //�D Q � /�J � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> WORK DESCRIP710N <br /> �1/Xa y ���:� � <br /> PLUMBING MECHANICAL <br /> Na. TYPE OF FIXTURE OA ITEM NO. TYpE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _, A/C—A/HAIJDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTI-IES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _. CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREP�ACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SER\'ICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER � _ OTHER <br /> L/lGati�'"�— � _ — <br /> — .�c,l-eT �� — <br /> I HEREBY CERITIFY THAT I HAVE REAU AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDI��ACES 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 6Y THE <br /> OWNER OF THIS PROP RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I CO�dPLY WITH THE STATE <br /> CONTRACTORS LAW 27 RCW AND 96.200 WAC. <br /> �: �s � ���� -pJ <br /> Si naWre of OwnedConlractodP.uthorized Agent Date <br /> ��� <br />