Laserfiche WebLink
!� cRMIT APPLICATI.JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />'t / <br />03oa- <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DES C. <br />OWNER '/ ADDRESS ZIP P(�HONE <br />"S' <br />: <br />jA /L4 / xek f �-� rIjj •�E <br />TENANT NAME <br />CONTACT NAME PHONE <br />CONTRACTOR �% / L 14' ADDRESS ZIP CONTR. LICENSE # <br />/ ��) <br />PHONE /� in � I ///o I�Z t—x4� �/�' — <br />PROPOSED USE OF BUILDING <br />al <br />HEAT SGIe RCE <br />Lion R <br />R CDom <br />Alteraion <br />I TVRRMIT <br />kiln S19mbing <br />B D <br />(WORK <br />B <br />14 <br />other <br />CONTRACT PRICE OF WORK-./-m-m. r/je/ <br />CITY OF EVER07 LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C-A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ _ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />1 <br />— <br />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 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 AUTH( 11ZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE S1 iTF. <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAD. <br />Signature of owner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />