Laserfiche WebLink
� �'ERMIT APPLICAI��N <br /> CITY OF EVERETT PERMIT SEFiVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PAqCEL TAX I.D. k PERMIT a / <br /> II� z� ��rn AJv�NvE � 005��}=i- c�Ol ool b2 . I �c� .2//- voy <br /> LEGA LOTNO. 1 BLOCKI TRACT <br /> DESC. <br /> OWNER ADDRE53 ZIP PHONE <br /> �1tb,GN�P�c.� � NG . I 12�5 l�ir►� /ri� GjE 9SZpS 425�3 1500 <br /> TENANTNAME I CONTACTNAME PHONE <br /> M�oN� � �►-� � •c,�.r�-�,K ��+ ��.��. <br /> CON7RACTOR AD�RESS Pp, �yx �j�2-}- ZJp CONTR.LICENSE N <br /> 1 .D. hlawroNcaN�TRtx�loi� �.YNNv�Ia�D �,p JpNEwo►9831.�i. <br /> PHONE 20% 4-2� 640``- �}StfS�iJ1�1P16?'DI`E �ci0� <br /> PROPOSED USE OF BUILDING Building Mechanical Addilion HEAT SOURCE <br /> PERMIT �ombinalion R Plumbing WORK g Alteration Electric ' <br /> TYPE emolition d Sign 7YPE D New Gas <br /> Sprinkler U pepair/Maint. x Olher �� <br /> CONTRACT PRICE OF WORK CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> WORK DES�RIPTION <br /> C�►.no►��ti o H e,� Ct�rVo1�ETG 'P'.h-�CJI� �t�Ll. I�U I l.�l�i I`!C� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR REM ' <br /> _ WATERCLOSET _ A/C-A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> __ LA1,'ATORY(WASH BASIU) HEAT PUMP <br /> _ S`iOWER _ UNIT HEATERS <br /> _ KITCIaEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER �I <br /> _ CLOTHES WASHER METAI FIREPLACE/STOVE I'! <br /> _ URINAL _ FIREPLACE INSERT ' <br /> _ DRINKING FGUNTAIN _ GAS FIREPLACE <br /> _ FLUOR DRAIN _ GAS RANGE f� <br /> _ BACKFLOW PREVENTER _ GAS?IPING i I <br /> _ SINK (SERVICE/BAWMOP/ETC.) _ EXHAUST FAN d' <br /> i = OTHER _ OTHER �I <br /> I = _ c <br /> I � <br /> i I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE'.'HER SPEC:FIED HEREIN OR � <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER i <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIO�V. THAT i AM AUTHORIZED BY THE i <br /> '� OW ER OF THIS PRCPERTY TO PERFORM THE WORK FOfl WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br /> i CO ACTORS LAW 18.27 RCW AND 296.200 WAG ! � <br /> i <br /> ; Q —a_✓�-r -��.�—�' l �—2�—^02— i ' <br /> Signature of OwnedContractor/Authorized Agent Date ! <br /> 4 <br />.� ,n � <br />