Laserfiche WebLink
SITE DRESS <br />��� a- L� <br />LEGA LOT N0. <br />DESC. <br />F�RMIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVICES a.,ao -o Z <br />3200 CEDAR STREET, EVERETT, WA 98201 Po �a�o� <br />425-257-8810 - FAX 425-257-8857 <br />PARCEL TAX I.D. # �PERMIT X - � <br />u .; � r-�G? . Gi:��; <br />BLOCK � TRACT <br />�-�+,� � _.,� <br />. r - <br />U % � `�. _ / r� -; � <br />TENANTNAME � CONTACTNAME PHONE <br />CONTRACTOR <br />PHONE �y�� ��1fJ/C�i <br />PROPOSED USE OF BUILDING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />��1�<..��,� <br />-�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER, <br />KITCHEN S�NK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ADDRESS <br />Building D Mechanical <br />PERMIT � Combination u Plumbing <br />TYPE Demolition �] Sign <br />Sprinkler <br />LP CONTR. LICENSE M <br />Addition HEAT SOURCE <br />WORK R Alteralior� (� Electric <br />T/PE D New D Gas <br />U Repair/Maint. U Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A!C — A/HANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEFEBY CERITIFY THAT I HAVE REA� AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEi3EIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AN\' OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OFl THE PERFOAMANCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED 8Y THE <br />OWNEF OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />Signalure ol OwnedCoNracrodAuthorized Agent Date <br />