Laserfiche WebLink
, <br /> PERMIT APPLIC�TION I <br /> CITY OF EVERETT PERMiT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 9P201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � -�o --/O � <br /> SITE AODRESS PARCEL TAX I.D.# PERM1IIT: <br /> �1p � � « f�� ,4Jc S� Z�os I`+co�}oaqcc� � /oo� - D�S <br /> �EGHL LOTNO. BLOCK TRACT <br /> DESC. I <br /> OWNER AODRESS ZIP PHONE <br /> G�aSw.l.... 52t�-lio� f�• n .[3�x 1393 '��-(�,.^4 � ln.i� �'d`jDl <br /> TFNANTNAME CONTACTFORPERMIT PHONE <br /> o ' (�� �.L�`�' q��o Sr�� '���.,��-� 2-��6 Zz-3 ��2'z._ <br /> CONTRACTOR .rJ�� a� 1 ADDRESS �o.� 4,T1J �� C ZIP CONTR.LICENSE# i <br /> �-� "I� J <br /> ��HONE �L� 6 ZZ�j \I ZZ S G/<� �1 I c� � C'I dI 3 9 `�I31`Prl7a` 311 I�S <br /> PROPOSEDUSEOFOUILDING Bulldi�g r" Mechanical Adtlitlon HEATSOURCE <br /> I PERMIT B Combinati0n PlUmbing WORK�hlteral�:.n � Electnc <br /> TYPE �� Demolitlon �Ign NPE New Gas <br /> 6 Sprinklet Repair/Mainl. Olher <br /> CONTRACT PRICE OF WORK �� "— CIN OF EVEREIT LOCAL SALES TA%CODE IS 1105 <br /> WORK OESCRIPTION <br /> lr.� STf-I,�- o�- i,.)rsLl. S lC,�,N <br /> PLUMBING MEGHANIGAL <br /> NO. NPE OF FIXTl1RE OR ITEh1 NO. TYPE OF FIXTl1RE OR ITEM <br /> N'ATER CLOSET(TOILET) PJC-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEAIS <br /> LAVATORY(WASH BASIIJ) HEFT FUMP <br /> SFi01VER UNIT HEATERS <br /> KIiCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISIiWASHER , RANGE HOOD <br /> LAUIJDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PRGVENTER GAS PIFING <br /> SINK(SEFVICE/BAR/P�tOP/ETCJ _ EXHAUST FAN I <br /> OTHSR OTHER ��. <br /> I _ _ _ I� <br /> I HER63Y CERITIFY THAT I HAVE R61D AfJD E.�.4h11\[D i HIS APPUCATION F,ND lWOW THE SAA9E TO BE TRUE A1D CORRECL ALL i <br /> PROVISIONS OF LA\VS AND ORIDINACES GOVcf:^:IhlG'HIS TYPE OF WORK VJILL 9E COh1PUED VJITFI WHETHER SPECIFIcD HEREIN OR <br /> NOT, iH"c GRAN7ING OF A PERP.tIT OOE�NOT PRESUI.fE"f0 GIVE AUTHORITY TO VIOIATE OR CANCEL THE PRO�ISION Or'AN1'OTHER , <br /> STATE OR LOCAI LAVV REGUlATI1JG CONSTRUCTION OR THF_PERFCR�AAIJCE OF CONSTRl1CT10N. THAT I AM AUTNORIZE�91'THE �, <br /> I UINNER OF TNIS PROPERTY TO�ERFOt�td THE VJOHK FOR\YNICH APPUCATION IS A1FlDc AND I COhiPLY 1^11TH THc STATE �� � <br /> CONTR.4CTORS I.A1h'18.27 RCW AND?96.2004VAC. <br /> �-- .`L Z . � •Fe% � ; <br /> Signature ot � ner 1�ct / uthorized Agent Date � _, I <br /> l_.� i� . --------- /C. I <br /> —' DEuiT 8 CREDIT CARDS ARE NOT ACCEPTED _J I <br /> � <br />