Laserfiche WebLink
R :RMIT APPLICATIC N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. M PERMIT u <br />VA Dy M 1 w 800 P�z�6 a <br />a7oa L) <br />LEGA LOT NO. BLOCK TRACT <br />^ <br />OESC. ;0 —�o( (Qa� —00 <br />OWNER ADDRESS ZIP PHONE <br />CA\j0& uye-lr2-- <br />TENANT NAME CONTACT NAME PHONE <br />-mkkc, Wou-w, e JL ooA <br />�Jece <br />CONTRACTOR ADDRESS L) �,K 3S'v ZIP CONTR. LICENSE N <br />-1-CMq 44uwK 4Y}t� IC111101- <br />Ct?OU'Z �.rnl4HrkI132�� <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Me.:hanical <br />Combination .II�''{�.Plumbing <br />(WORK <br />TYPE, <br />Addition <br />Alteration <br />New <br />I HEATSOURCE <br />Q Electric <br />as <br />TYPE <br />Demolition U sign <br />Sprinkler <br />LLL J Repair/Maint. <br />U Other <br />CONTRACT PRICE OF WORK I SCp �—'' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION (nSk�11 SiYlk tl� fUblIC, U6yj <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />_ <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />— <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />_ <br />CLOTHES WASHER <br />FIREPLACE INSERT <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />__ <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />iOTHER <br />= <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO RE TRUE AND CORRECT. ALL <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL TE OR CANCEL THE PROVISION OF ANY OTHER <br />NOT. <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 WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA R 18 27 'D 296.200 WAC. <br />Date <br />Signature o 0wner/ o tractor/Aulhonzed Agent <br />