Laserfiche WebLink
I SITE ADDRESS <br />I 5�1�h-9�" <br />I LEGPLI LJT NO. <br />DESC.P aI <br />j OWNER <br />�i �cQa�(L�� <br />TENANTNAME <br />PcRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />��� <br />CO(N�TRACTQR <br />F-t cSiGl. �(�.. �Z,i�t,l'(ZlS � �l- 'L <br />PHONE � � <br />i PROPOSED USE OF BU�LDING <br />� 5 � r��\� Fm.w.�u'� <br />CONTRACT PRICE OF WORK <br />WORK UESCRIPTION <br />���w�� ��� <br />PARCEL TAX I.D. # <br />3-ncK uto �ac Ok�,a <br />TRAC'i <br />x <br />l'103a-'�����5� �VPi�9.Q Q�ota- �-la�-iy��l7 <br />CONTACTFOR PERMIT <br />�.jcJ 1_�SS� <br />PHONE <br />�{�$�'l"13-lil� <br />ADDRESS ZIP CONTR. LICENSE # <br />�"1038 -3 ���ES� i,�,a�34-4Csoia- I�ORL2r �o3aL <br />Building jjj���---��M1 lechanical <br />PEfiMi7 -Combination j�-Plumbing <br />TYPe Demolilion � Sign <br />S�rinkler <br />Addition <br />WORK Alteration <br />TYPE w <br />P.epairlMaint. <br />HEATSOURCE <br />ElecUic <br />s <br />Other <br />qTY OF EVERE i i LOCAL SALES TAX CODE IS 3105 <br />� <br />NO. � TYPE OF FIXTURE OR ITEtd <br />:� WATER CLOSET (TOILET) <br />� BATHTUB <br />5 LAVATORY (WASH BASIN) <br />i SHOWER <br />� KITCHEN SINK 8 DISPOSAL � ��.1; �� <br />_j_ DISHWASHER <br />i LAUNDRY TRAY ����,� <br />� CLOTHES WASHER <br />_ UR�NAL � S �Q-��.�� <br />= DRINKING FOUNTAIN S�� , \ � <br />FLOOR DRAIN A <br />_ BACKFLOW PREVENTER �,� �� q� <br />_ SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTURE OR ITEM . <br />.A/G-A/HANDLING UNITS <br />� FORCED HIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER. <br />� RANGEHOOD�t1�c�� <br />� WATER HEATEP, <br />METAL FIREPLACG'STOVE <br />FIREPLACE INSERT <br />� GAS FIREPLACE <br />� GAS RANGE <br />5 GAS PIPING <br />� EXHAUST FAN <br />OTHeR <br />I HEREBY CERITIFY THAT I HAVE REAO AND EXAM1IINED TtiIS .4PPLICATION AND KNOW THE SAM11E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF AWS AND ORIDIN^,CES GOVERNING THIS TYPE OF �A'ORK WILL BE COMP{iED WITH'�NHETHER SPECIFIE� HEREIN OR <br />N07. THE GRANTWG OF A PERAIC DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLFTE OR CANCEL THE PROVISION OF AYY OTHER <br />STATE OR LOCAL LAW REGULAT'NG CONSTRUCTION OR THE PERfORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OP THIS PROPERTI' TO FSRFORPd THE WORK FOR WHICH APPLI�ATION IS IdAD[ AND I COMPLY WITH THE SThTE <br />CONTRACTORS LAIV 1 B27 RC`.V AP.'D 2cn 70(1 WAC <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />