Laserfiche WebLink
P�RMIT APPLICATIO�N <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.# PERMi7 a <br /> ' 93� ��ck��� Ppyo�oi <br /> LFGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> TENANT NAME CONTACT FOR PERMIi PHONE <br /> I Je� l�+yanf �(a,S 3/0 - 5�3c� <br /> CONTRACTOR ����Q`y��S�� �f V��.. ��n� AD�RESS �A <br /> ! �C7I % I b y PL SL= ZIP CONTR.LICENSE K <br /> PHONE yas-ar� � �-�ao �3o���; �✓d Sj'iotk�P.X96Yoz <br /> 9o�,ia <br /> PROPOSED USE OF BUILDING I n Building hanical Atlditlon HEAT SOURCE <br /> PERMIT r5 Combination lumbing IWORK AlteraUon � Elennc <br /> TVPE �,_� Demoiition Sign TYFE Ne Gas <br /> U Sprinkler epalrMlaint. OMer <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORK DESCRIP'�ION n 'Q�� �`S� � . <br /> W � V'2-�!` $l'ri.� K <br /> RLUMBING �� MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-AlHANDLING UNITS <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/QAR/MOP/ETC.) EXHAUST FAN <br /> � OTHER v�i��- sen,�cq OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND K1JOW THE SAME TO BE TkUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> INOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27�. l�NB-49 200 WAC. <br /> � ,�/a�/��� <br /> Signature o(Owner ntrectodA�tf onzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARF NOT ACCEPTED <br />