Laserfiche WebLink
� I<o4oa -0�0�1 <br />SITE ADDRESS ptiRCEL TAX I.D. N PERP.uT a <br />% �) D U �y✓c�.�t2iV �/`�E7 � �-"-�j`b�- <br />LEGA LOTNO. BLOCK TRACT <br />OESC. <br />OWNER /� A�DRESS ZIP PNONE <br />L�j'C ��%%/� % ' •' �rIL3 �-�%��� <br />TENANT NAP.1E � CONTACT NAh7E PHONE <br />Ci%;vtic� �✓�'s �l/4dG� I Van� �OC/�v ZS.3-<By -�yz7 <br />P;�"RMIT APPLICATI(''V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />CONTRACTOR U7�� <br />l,b <br />PHONE 253_� 13 / �.� y2 � <br />PFiOPOSEO USE OF BUILOING <br />.QG7� G'C�tE.F,[y/f-' <br />:E:'i�v—�-rld <br />ADDRESS 2,�-7 <br />i <br />/.4cJ/y1+1J <br />7i�'N,�1!/G - L . <br />WQ <br />Building Aiechanical <br />PERMIT � Combinalion R Plumbing WORI <br />TYPE �emolilion � Sign TYPE <br />Sprinkler <br />CONTRACT PRICE OF WORK �' J 2 �v <br />, �sv- <br />ZIP <br />9+'yz r <br />CONTR. LICENSE il <br />�/I/,�f'Di>�/= <br />j� Addition <br />r`j Alteralion <br />F_� New <br />LJ qepair/hlaint. <br />HEATSOURCE <br />Electric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />WORK DESCRIPTION <br />/��r,n�c �-i,c�� .s�.wi✓i�Lek �y�E�ir,s �kro��F✓,�o��� G�liJ7i�v�., Cvi�%r.vb� �,�-o �G'ry� <br />P o-�ii/o.v, <br />NO. I TYPE OF FIXTURE OR ITEM <br />WAT[R CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />_ � KITCHEN SINK 8 DISPOSAL <br />� �ISHWASHC-R <br />W,UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/�TC.) <br />' �l, OTHER �f7Fi//itlr.'Rs <br />NO. I TYFE OF FIXTURE OR ITEAI <br />A/C — AJHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />PAETAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />I HEREBY CERI7IFY'HAT I HA'JE READ AND EXAh11NED THIS APPUCdTION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF I�'NS AN� ORIDINACES GOVEflNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHFR SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERh11T DOES NOT PqESUh1E TO GIVE AUTHORITY TO `."OLATE OR CANCEL THE PROVISION Of ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM11 AUTHORIZED BY THE <br />�`NNER OF'HIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS PdADE AND I CO�dP! Y WITH THE STATE <br />TRACTORS :�(J �8.27 RCW A 9620D WAC. <br />% <br />� Z / �y <br />Signalure o wnedContraclor/Authorized Agent Dale (/ <br />