Laserfiche WebLink
APPLICAT 7N FOR CONSTRU( 'ION PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> �200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> p OMBINATION ❑ BUILDIN(i ❑ IiAECHANICAL ❑ PLUMBINO ❑ SIGN <br /> P ESS: �r—'��9 �b�Il'�S I—YVL-� �`-�" �� <br /> p �\�pq��5 CITY 21P PNONE <br /> �.��.����.bl� ��ta� la�' OR. �'K��, r��, q8a`rs a���9�- l�s�� <br /> IEWiMT WYL�DUAE55 CrtY ZtV P�qNE <br /> IYICW�ECTqi0E5�GMER 4Wl/d1DRE55 GITY ZIP PNONE <br /> GENEq/yCpNTMCTqI IWLADDRE55 GITY 21f' PiIONE StATELICENSE• <br /> <r4�n�=, <br /> ���C� y��pppE� CITY IIG GNONE STATELICENSE• <br /> p�WAWGCpNTqk70p 4IulA0DNE53 CITY ZIP PHONE STATEtKENSE• <br /> C0"'""CTP/1�0FM'0P1 HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OESUIlEWqiKAN�50UMEFOO��GEWVOLVED LONT�CT RS�NNIDP , <br /> C/ � �` <br /> 5�' 9 �- b1� <br /> ` I FIEREBV CERTIFV THAT I HAVE READ AND E%MIINED THIS <br /> �(�. 1�1 S APVUCATION AND KNOW THE SAME TO BE TRUE AND C4NRECT ALL <br /> nqros[o��SE or au� PROVISIONS OF UWS AND ORDFNANCES GOVERNING TW�?VPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED liEAE1M OR � <br /> �µp� ,�fpNppp�ppEpry�S�pWp9ElOWd1AR/iGN7WOCOME 1 \ NOT. THE��RANTING OF A PERMIT DOES NOT PRESUME Ti? 4.�VE <br /> �oT�1 � '�'1 �� � � J AUTHORITV TO VIOUTE OR CANCEL THE PROVISION OF �DfV <br /> �� °�� OTHER STl�TE OR LOCAL LAW REGULATINCi CONSTqUCT10N OR TF� <br /> �Ql daa_ _ a a PERFOiiMANCE OF CONSTRUCTION.THAT I AM AUTHORIIED BV THE <br /> v OWNER Of THIS PROPERTV TO PERFORM THE WORK fOR WH1CM <br /> APPLICATION IS MADE AND 1 COMPLV WITH TH�. STATE <br /> �a i�'.o.��p CONTRACT(?RS LAW 1827 RCW AND 296200 WAC. <br /> sti�o -a�,�,- oa� -oo - o� - P ��; d� ��r� � � -ao- 4� <br /> COIL511NlC710N LWN LENDER.AOORESS.IEIEN��NUMBER j( <br /> SION�TURE U�7E <br /> CIIY BUSINE55 LICENSE NO <br /> �� ��MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM FEE NO. TMPE OF EOUIPMEMT fEE <br /> WATERCLOSET(TOILE� � NC—n°a+NIXAUNff3 � <br /> �TM� � FORCED AIN SVSTEMS � � <br /> VATORV(WASH BASIN) � T PUMP ' <br /> S ER ' U HEA7ERS , � <br /> KR SINF(8 DISP i CLO ES DRVERS ' <br /> � dSHW R � RANO D � <br /> LAUNDRY � WATER TER _ <br /> CLOTHES W � WOOD ST <br /> Up�� MEfAI FIREP (WOOD BURNING) <br /> DRINKIN(i FOIXdTA1N � FIREPLACE INSE BURNING) � <br /> FLOOR DRAIN GAS FIREPLACE � <br /> BACKROW PigVENTERS ; GAS RANGE ' <br /> SINK(SERVICE—BAR.ETC.) � GAS F�P�NG <br /> IXHAUST FAN <br /> � <br /> i <br /> � <br /> � <br /> � <br /> � e <br /> SUB TOTAL f SUB TOTAL S i <br /> PERMIT S PERMIT f � <br /> TOTALFEE f TOTALFEE S _ <br /> POR OFFlCE USE ONLY: — <br /> FNONT SEIB/AC�k7 REM SETM�C7N SIOE SETBi1CR <br /> ounurtc.�a ree necEmTrw <br /> ZV �v � ' FEES MALUATIOM FEE <br /> �S tOT�aE� VM;�Nt 51tE <br /> Z ❑YES ❑NO B1NlUiH(; ' <br /> NEN3Ml TI110y�'I� U�IJITOFDN'EL4NG ����8�D f�(f� Fl�(t MJMBING .� <br /> 3 F. C./V/A/ �' <br /> G Z S. <br /> p��Up11NCV NO 0�St(MUE$ OCCIA�NT LO�O ���NT � MECN�NIC�I _ <br /> �"3 �"� � Y ❑YES <br /> ♦DqTIONN VL�N CNF.GK <br /> FIRE SPRINKLER REO'D ��� <br /> OTHER I <br /> FlPE NMM REO'0 RE�SOM .:� _ � I <br /> � SUTE BNLOwf,StMCH�xE <br /> TYYE OF f,ONST Ol11N511PFarn�o qv CRV OF EVEREIT ���Bl lf.WOPNS _ <br /> JIQ IOCAISALES �— <br /> oeTe Z 22 (o TA%CODE IS 3105 7oUl <br />