Laserfiche WebLink
PERMIT APPLICAI ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. IT PERMIT a <br /> ,-4L/t 9 Mo312 0l5 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Mi Ke f '�/inc� C�/ 1 6/' s/1- 'S.j . Va5- a30 -8-03 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE 0 <br /> -t/ecri;e,1ke&oa <br /> PHONE SIIG/jGiX/ �, 6lJrr. i`�" !/ �CL�>T2—al;��ZG�9�rJ <br /> _ o3Ua Sok ?L _ <br /> PROPOSED USE OF BUILDING I:uilding Mechanical Addition HEAT SOURCE <br /> PERMIT R Combination Plumbing WORK Alteration Eleclnc <br /> TYPE B Demolition Sign TYPE New Gas <br /> Sprinkler I Repair/Malo'. Other <br /> CONTRACT PRICE OF WORK q&,, OF EVERETT LOCAL SALESTAX CODE IS 3105 <br /> WORK DESCRIPTION 111_VX&gK7M O/ •2. S j/l /-11 /,S v/ /tj/� ale--/ IO/4,c-) <br /> ,LeCer ,s>Lr�� rutC[ YrtGi/ica s�ia`, dM E/eeh-el l' - iu�- dle&4er, . <br /> v�u�tzve/'�C, �ciE c�✓r;��a/, �i,��/ytrn�i�n �cd�f<f� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i <br /> _ <br /> WATER CLOSET(TOILET) Ai•.:—A/HANDLINGUNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY 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 PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BARIMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 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 PROP TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CTORS LAW 6. RC AND 296.200 WAC. <br /> � � <br /> Signature o Owner/ tractor! uthonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />