Laserfiche WebLink
F AMIT APPLICATIC'M <br />00;�r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />IZ-3y4L5--• <br />PARCEL TAX I.D. # <br />PERVIIT N <br />-Ci <br />v0s �l90o zo3 Yo< <br />2v <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. -2 �3 3 <br />0D.2 ji— <br />OWNER ADDRESS ZIP PHONE <br />a�FF C'f,-O(.�w, yt4AsL z - 3y sj. �6w, <br />TENANT NAME <br />CONTACT NAME PHONE <br />CONTRACTOR Y,4N St yCL_ 4S5 OC 1.47TJPDRESS Pp SOX 13O�G ZIP CONTR. LICENSE N <br />rlBzoG <br />PHONE 021 p0 <br />Y�'s Vi4Ns<0.) <br />30ij S4 <br />0 <br />PROPOSED USE OF BUILDING <br />Building li Mechanical <br />PERMIT Combination IIL--,(( Plumbing <br />Addition <br />WORK Alteration <br />HEAT SOURCE <br />D Electric <br />S� <br />TYPE Demolition Sign <br />Sprinkler <br />TYPE New <br />Repair/Maint. <br />Au1 Gas <br />7"f Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />AD I> bF-Ck< 4NP GIoS E--r Re?, C 4ry ENM �. Do a f2--/ <br />/ <br />_— Cep .S_. <br />li✓ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR I"EM <br />NO. I 1YPE OF FIXTURE OR REM <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME i O BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT 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 THIS PROPERTY T9 PERFOA THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT LAW 18.27 AN 6.200 WAC. <br />— /S-OY <br />Si ature of wner/C c Authorized Agent Date <br />'/a <br />