Laserfiche WebLink
��RMIT APPLICATII,N <br />P�:RMIT APPLI�.ATII,N <br />CITY OF EVERETT PERMIT SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />A25-25)-BB10—FW(425�25]-885]—www.everellwa.orq <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM TO -OEBITBCREDIT LAP�B ARE ACCEPTED <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PARCEL I.D. <br />P MRN <br />P MIT IM <br />ie� <br />%t, f1i � <br />�i <br />3L <br />1 7�7 37, <br />_ a <br />� A <br />57j7 <br />�� LOT NO. a,o�. <br />LEGA LOT NO. � BLOCK <br />�� <br />..«. <br />TRACT <br />oesc <br />DESC. <br />owxea <br />OWNER ADDRESS CITY2IP PHONE <br />�oone3f �, ire vxoxe <br />p <br />¢JdS .N,kI�C� l!9</�>r' 9h 3Yp5Go <br />Y %[ly �✓li �CII/�!D �����<ilr7 �y'•3Y�S"Le <br />TENANT NAME <br />TENANT NAME <br />CONTACT FOR PERMIT pHp1E^ <br />CONTACT FOR PERMIT PHONE <br />romxacron �oonass E. Wn1 9F.,rcmrzm exoxE <br />CONTRACTOR �,,/([„ �G ✓ ADDRESS � CITY/ZIP PHONE <br />.( r�s <br />CONTR. LICENSE # ���,y�,� � <br />cartrs. ucexsee{il�%�� <br />7 J <br />USE OF BUILDING <br />USE OF BUILDING? <br />HEATSOURCE <br />HEAT SOURCE <br />CONTRACT ICE OF WORK <br />CONTRACT ICE OF WORK <br />( <br />_Electric _Gas _Other <br />�/ <br />�5.�5(% <br />WORN DESCRIPTION O <br />WORK DESCRIPTION <br />PLUMBING <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />NO. <br />NO. <br />TYPE Cf FIIIIVPE OR <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />NO. <br />TYPE FIXTURE qi REM <br />TYPE OF FIXTURE OR ITEM <br />_ <br />ao-:,o-��arre ��n. <br />A/C —air handling units <br />l oilet <br />mnoi <br />_ <br />AaIMUL <br />Bathtub <br />Forced ai�syslem: <br />Forced air systems <br />_ <br />Lavatory (wash bash) <br />Lavatory (wash basin) <br />— <br />Gas piping <br />Gas piping <br />_ <br />Shower <br />Shower <br />Water heater <br />Water heater <br />_ <br />Kitchen sYik84iapJsal <br />Kitchen sink &disposal <br />as fireplace <br />Gas fireplace <br />_ <br />Dishwasher <br />Dishwasher <br />_Gas <br />Gas �arxp <br />range <br />Clothes washer <br />Clothes washer <br />Clothes dryer <br />CIo1M1e4 dryer <br />_ <br />Laundry tray <br />Laundry tray <br />Range hood <br />Range hood <br />_ <br />5'mk (00 mNa�Mroplelc.� <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Exhaust fan <br />6echfow p�eV�nler <br />Backfow prevenler <br />Heal pump <br />Heat pump <br />_ <br />— <br />Urinal <br />Urinal <br />— <br />Vml Maier <br />Unit heater <br />_ <br />o�mx.re vo��um <br />Drinking Fountain <br />— <br />Boiler <br />Boiler <br />_ <br />Floor drain <br />Floor drain <br />eem�e�auo� <br />Refrigeration <br />_ <br />Grew trap <br />Grease trap <br />WeMslove <br />Woodstove <br />_ <br />Roof drains <br />Roof drains <br />glqr <br />Other <br />= <br />Othar <br />Other <br />CITY OF EVERERLCGPl3Av[y ip1I t00E 15 )105 <br />CITY OF EVERETT LOCAL SALtS TAX CODE IS 3105 <br />I M1o�eUy [entity Ilal l have matl and examined IMS application and know the same to be V49 and correct. All provisions of laws and <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />oNln:'esyovernlnB ���I51ygolwu�twillWcom011¢a with whether specified or not. 11ie granting of Ve�milOces not presume <br />ordin� :es governing this type of work will be complied with whether specifiod herein or not. The granting of a permit does not presume <br />to yive authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />to give authority loviolal4o cancel lea provision of any other state or regulating construction or the performance o1 <br />minus. meu am authorized yineovmero�m�s property yenonn the mrwn'wn application and �rompW with ��re <br />construction. That I am aulltorized by the owner of this property to perform the work for which application is made and I comply with the <br />Sta o ntractor/s Law 27 , W and 296.200 WAC. <br />Mro brt Lew R] J29fi Y00 WqC. <br />� <br />J�J e <br />i�SY <br />STuR 01 h�cbrlPUl�oRaf 1 Oak <br />Signature o O ne / onlractor/Authorized Agent Date <br />