Laserfiche WebLink
P�RMiT APPLICA'TIO�I � <br /> � <br /> CITY OF EVERETT PERMIT �ERVICES I <br /> 3200 CEDAR STREGT, EVERETT, WA 98201 <br /> 425-257•8810 - FAX 4?_5-257-8857 � _l�_�� i <br /> SITE ADDRESS1 PARCEL TAX I.D.# PERMIT# , <br /> i <br /> ' � t'� U�7� - �l� � <br /> c Di-.=9 ` nSr�uere <br /> LEGAL LOTNO. BLOCK TRACT I <br /> DESC. <br /> OWNER ADURE55 ZIP PHONE � <br /> �e�?-�- �aV���'�f? !v�/���'"StLv��-cf�- 18�L'� ydS-�"�-3Go� I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �/ ADDRESS ZIP CONTR.LICENSE# i <br /> PHONE / /' �/j�j.� � <br /> r✓L�� �/ / :� �. � <br /> I <br /> PROPOSED USE OF BUILDING Building I� Mechanical Addition HEAT SOURCE � <br /> PERMIT R Combinafion H Plumbing WORK � Alteration �Electric I <br /> TYPE D Demolition Ll Sign 7YPE New Gas <br /> U Sp�inkle� Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS I <br /> LAVATORY(WASH BASIN) HEAT PUMP ' <br /> SHi.WER UNiT HEATERS <br /> KITCHEN SINK 8�ISPOSAL CLOTHES DRYER <br /> DISHINASHER RANGE HOOD <br /> LAUNDRY TRAY WA'i�R HEATER <br />' CLOTHES�VASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> � _ CTHER OTHE <br /> � Pcl�C i vver <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL i <br /> PROVISICNS OF LAWS AND ORIDINACFS GOVERNING THIS NPE OF WORK WILlBE COMPLIED WITH WHETHER SPECIFI.`J HEREIN OR <br /> NOT. THE GRANTING OF A PERA9IT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THJS PR ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> 2QATJ2ACT0 LA 1�.27 RCW AN�256.200 WNC. ,r'7 ���/ <br /> \ i <br /> I � <br /> Signature of Own d ontractodAulhonzed Agent Date <br /> � __ DEBIT S CREDIT CARDS ARE NOT ACCEPTED �I <br />