Laserfiche WebLink
d�`_ <br /> PERMIT aPPLIGATION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ' <br /> 425-257-8810- FAX 425-2F,7-BR57 � <br /> --- Pl� 3oS-�� �l <br /> S�TE AD �I,�� �` �, � �ARCEL TAX�..7.# PERMIT a <br /> �S� ,�� lJ� . ���1 . Q`�-I n �>��n I e. �os _o,o <br /> LEGAL LOT NO. BLOCK � TRA��.a�`N,����� �`_�j� , �' <br /> DESC. <br /> OWNER AD�RESS <br /> .,ZIP PHONE . <br /> Cc�.�_Cyc r��n,�. \�\���\�-�c_k����t�,`W��I,���,`��,y�P. �`t�a��a , <br /> TENANTNAME CONTACTNAME (�I�r�� r�k PHONE f�lL � <br /> �\� I V�\\C \�a`=1\�1.��.0 'J.Y"� .Cl'IJ�J J��I'�J�� 0 � J�..l" ��I�� I, <br /> CO�J fRACTOR ADDRESS ZIP CONTR.LICENSE p � <br /> PHONE \�M{�' C�.QC��i�G.3�N( I <br /> J G EkP. 101 J�I '�'; � <br /> PROPOSE�USE OF BUIL�ING Building Mechenical Addition HEAT SOURCE I <br /> ti.,. !!!��� PERMIT Combinalion Piumbing WOFlK n��emtion Ei�cvic <br /> S � � TYPE Demolilion �Sign TYPE �N�w �Gas <br /> Sprinkler(a of hoads) FepalrlMninL Other <br /> CONTRACT PRIrE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTIC N <br /> ����� \��p1 i <br /> ����\C `�'-)� � V�� ' <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTUflE OR ITEM NO. TYPE OF FIXTURE OR ITEI.7 <br /> WATER CLOSET(TOI�ET) A!C-- �1FIANDLING UNITS <br /> BATHTUB _ FOHCL D AIR SYSTEMS <br /> '� LAVATORY(WASH BASIN) HEAT f�UIv1P i <br /> SHOWER Uh�T FIEATERS � <br /> � KITCHEN SINK 8 DISPOSAL � CLOI'FIES DRYER I <br /> � DISHWASHER � RANGf_ HOOD <br /> LAUNDRY TRAV � WATEfi!-IE�TFR <br /> � CIOTHE�WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIFEPL.A.CE INSERT <br /> _ DRINKIN=FOUNTAIN � GAS FIRFPLACE <br /> _ FLOOR DRAIN � GAS RA�1GE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SER'JICElBAR/MOP/ET0.) _ EXHAUST FAN <br /> __ OTHER _ OTHEFi <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS P.PPLICATION AND KNOW THE ShME TO BE TRUE AND COFRECT. ALL <br /> PNOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK W�LL BE COh1PlIED WIiH WHEfHER SPECIFIED HEREIN OR <br /> NOT. TI�IE GRANTING Of�PERMIT DOES NOT PRESUME TO GIVe AUT40RITY TO VIOLATC OR CAIJCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATIiVG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFI2ED BY THE <br /> OWNER THIS PROPERN TO PERFORM THE WORK FOR bVNICH APPIICATION IS MADE AND i COMPLY WITH THE STATE <br /> GONT AC� ��27 R�ND 296.200 WAC. <br /> �/l�/, ; � <br /> SignaWre ol OwnedConlractor/Authonzed Ayent Dal2 i/L <br /> _ _.._ j <br />