Laserfiche WebLink
P�:RMIT APPLICATI(, �V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> �UZc�S—U��S <br /> SITE ADDRESS PARCEL TAX I.D.N PERMI7 a <br /> 54Z8 Pav viPu► e 0080 3o0od I �0 205- <br /> LEGA LOT NO. BLOCK TRACT I,, T <br /> DESC. Z— N �U � �IJ�V��J��� <br /> OWNER ADDRESS ZIP PMONE <br /> Mic�nc.ie� Pa�iS� S�hZ$ (�,rkview �-ov�e � Evev-e� 9$20?, 4z5-353-67/0 <br /> TENANTNAME CONTACTNAME PHONE <br /> Nlic�nae� Po,�OiS� Mic�e� Po.�iS� 4z5-353-67I0 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> ��,t1VlC'U' (Mic�tae� �[�jsz) S�FZS PaUkv�yiew I�ke 98203 ��� <br /> PHONE (�.ZS-3S3-07IO ����` <br /> PROPOSED USE OF BUILOING �3 Building f"1 Mechanical Addition HEAT SOURCE <br /> PERMIT �} Combination K Plumbing WORK � Alteralion � Electric <br /> �� �'P�('O� �S�O 7YPE D Derimolilion LJ Sign 7YPE New Gas <br /> �� �� Sprinkler Repair/MainL Other <br /> CONTRACT PRICE OF WORK J�J�rj — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> / l/ <br /> WORK DESCRIP170N <br /> Bui�, ov� �"o exis�i�� c�,e�k . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES ORYER <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 DRA�N GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> I = SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> I <br /> I <br /> iI HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1W5 AND OAIDINACES GOVERNING THIS TY?E OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PAOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> j OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B 7 CW AND 296200 WAC. � <br /> �� � � � , � 5/6/0 Z <br /> Signature oi Ow dContract ulhorized Agent Date <br />