Laserfiche WebLink
P[, �MIT APPLICATIG.J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FAX 425-257-8857 � `J3 `D� <br /> SITE 4DORESS PARCEL TAX I.D.K PERMi7 a <br /> �� f� �S /.�U� M ��o0- v� "I <br /> LEGAL LOT N0. BLOCK TRACT <br /> D-1 <br /> OWNER ADDRESS ZIP PHON �- <br /> R/1'1L� AC'CE7TGl1Q0 !r��S OAY..�3 f�UL� �-?JERb"'r`f 4�'.� / <br /> TENA NAME I CONTACTNAME PHONE <br /> CONTRACTOR n'�, I,�,^�,T1 J r A ADDRESS ZIP�jCONTR.LICENSE N <br /> c_ lf /V C� l4�15 RR�AD l,�J,� <br /> PNONE / / /�UCJZE TT WA' ��" _��� � <br /> (D IO <br /> PROPOSED USE OF BUILUING Building Mechanical Addition HEAT SOURCE <br /> PERMIT R Combinalio Plumbing WORK R Alleration � Electric <br /> �a,�,�-,�r,,�� TYPE g Demolition Sign TYPE g New Gas <br /> Sprinkler RepaidMaim. O�her <br /> CONTRACT PRICE OF WOR ' I Q� pr. CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> CJ <br /> WORK DESCRIPTION <br /> , ��gs P7 P � -�a u�A--rE� t�r-�7-�rL � �'�RE p�� c� <br /> PLUM8ING MECHANICAL <br /> iNO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> � WATERCLOSE7 A/C—A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> ! SHOWER UNIT HEATERS <br /> I _ K!TCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> i = DISHWASHER = AANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> i _ CLO7HES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> I — SINK fSERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I� — — <br /> I _ <br /> i <br /> I HERE 3Y CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORAECT. ALL <br /> PROVISIONS OF L1W5 AND ORIDINACES GOVERNINr,THIS TYPE OF WORK WILL BE COMPLIED WITH WHE7HEA SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISICN OF ANV OTHER <br /> STATE OR LOCdL LAW FEGUTATING CONSTRUCTION OR THE PERFOR6IANCE OP CONSTRUCTION THAT I AM AUTHORIZED BY TFiE <br /> , ("�WNER OF THIS PROPEPTY TO PERFORM THE WORK FO(i WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ; 'TRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �G�l l�ho ,yyt �t�i DD <br /> Signature ol O�vnedContractodAu orized Agent � Date <br />