Laserfiche WebLink
� `� ERMIT APPLICAI �JN "-' �-` � '� <br /> I, <br /> i CITY OF EVERETT PERMIT SERVICES <br /> � � 3200 CEDAR STREET, EVERETf, WA 98201 <br /> i ' '� ��425-257-8810- FAX 425•257-8857 �i <br /> ISITE ADDFESS PARCEL TAX I.D.N I PEP.MIT I <br /> �l� �a�c(r(G AY� . I �OZ// OJ� � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE 255� 101Z <br /> 4�Rolu7E�-�r'.� 8vE'i��1T M�CK4J-G�tfF�-�91ro f�GIF(G d.V�s ff�t'JO�C 10(p-1, �vE�.'CS" %8 (v <br /> TENANT NAtdE CONTACT NAME PHONE I <br /> �� ��p�►r�a ,�.��rn�iF�sz� �v��-1 �aYw4z 25°J-D8�o8 <br /> rn <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M I <br /> '. ra��( co�.� 1�o t�X ��'1'� S�Jak�t��jf-} °J82�1 �ciieT�cA2"12a i <br /> PHONE <br /> C�,r,o7 5Cc8- ?31�15 I <br /> PROPOSED USE OF BUiLDING �i7C� Building Mechanical QQQ AtldNon MEAT SOURCE I <br /> � If�(�1�QL =,'(.� PERMIT � ) Combination R Plcmbiny WORK py Atteration (� Electnc i <br /> TYPE D Demolilion d Sign TYPE R New Gas � <br /> � ��-'K���'{7 U Sprinkler V Repair/fdain�. O+her i <br /> I CONTRACT PRICE OF WORK � �Pjp� Q�Q, OD qTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ! -- <br /> I �VORK[`ESCRIPTION ..�-�AY1-�- IMt'FzOJ�MEF-1'(�J �-1 "Tl-1�. � �l.Q^�Z Or' 1�`J`rtG'�''IdC-I�1G I <br /> � GfVvl�Ll�j. <br /> IPLUMBING I MECHANICAL I <br /> I NO. TYPE OF FIXTURE OR ITEId NO. TYPE OF FIXTURE OR ITEM <br /> � <br /> WATER CLOSET A!C-A/HP.NDLING UNITS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> �, _ LAVATORY (WASH BASIN) _ HEAT PUMP I <br /> SHOWER _ UNIT HEATERS <br /> KITC iEN SINK 8 DISPOSAL _ CLO?HFS DRYER I <br /> i DISHWASHEP _ RANGE HOOD I <br /> I LAUNDRY TRAI' _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> UPINAL FIREPLACE INSERT <br /> , DFINKING FOUNTAIN . _ GAS FIREPLACE <br /> i FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIPING <br /> � SINK (SERVICErBAR/IdOP/ETC.) _ EXHAUST FAN � <br /> OTHER_ _ OTHER <br /> — � <br /> — — I <br /> — — I -- II <br /> I HEREBY CEFITIFY THAT I HAVE READ AND[XA1dINED THIS APPUCATION AND KtJ0�1'THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIC'iN5 GF UWS AND ORIDINACES GOV69NING THIS TVPE OF WOPK WILL BE CGIdPLIED WITH WHE7HcH SPECIFIED HEFEIN OF I <br /> fJOT THE GRANTItJG OF A PER�AIT OGES NUT pqESUME TO GIVE AUTHORI Il'70 VIOLATE OF CANCEL TH[PROVISION OF AIJY OTHER i <br /> STATE OA LOCAL LAW REGULATING CONSTRUC,TION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I PM AUTHORIZED BY THE <br /> � ON :R OF THIS PFlOPERTY TO PERFORM THF_WOFK FOR WNICH APPLICATIO'J IS 61/+DE 4N�I COMPLV WITH THE 57aTE � <br /> CONTRACTORS LAW 1827 RCLV AW 2962CG WAC. I <br /> 11, "1. p2 <br /> � nature o� wnerl tor Authonzed Agent Date � <br /> /� <br /> i � <br />