Laserfiche WebLink
� <br />APPLICATION FOR CONSTRUCTIuN <br />rne e�ero�een TO BE COMPLETED IN INK—PLEASE PRINT <br />CITV OF � � �+ � <br />everet� f HEATING SYSTEM: ❑ GAS ` I.ECTRIC O_ <br />BUILDING DEPARTMENT <br />259-8810 <br />' 1 DEMOLITION ' COMBINATION BUILDING MECHANICAL <br />PERMIT <br />! PLUV181NG <br />OWNER ,���_ MAILA�DRE55 Gnv ar rnurv[ <br />w�n¢t.a,J ��d2S 3rvtvv..y fSvrp L'Ve�.G 9�3 35r�-�5S- <br />TENRNT MFILA�DRESS fITY ZIP PNONE <br />ST ,� <br />ARGHITE�TpR GESIGNER MRIL AO�RE55 CITY ZIP PHONE <br />�/tJ+�l� <br />GENEPRL CONTRRCTOR MRIL ADDPE55 CITY ZIP PHONE LICENSE � <br />IAECMANICALCONTRALTOR M�ILAD�RE55 <br />GITY ZIP PMONE LICENSE I <br />everett <br />e <br />; SIGN <br />GLUMBIN4 CONTRALTOR MAIL ADORESS CITV ZIP PNONE LICENSE � <br />SaHLt <br />LUSS OF WORK <br />❑ NEW I6!�ABDITION i.' ALTERATION :.. REPAIR i_; DEMOLITION i�� WOODSTOVE/FRPL INSEHT ❑ BUILDING RELOCATION <br />Q� / D�,` �� O7v y .'� CONTAC7 PERSON AND PHONE NO.` �'�' �T ' <br />O� <br />`I:OLVED <br />PROPOSED USE OF BURDINO <br />LEGAL DESCRIPTION OF PROPER7Y �SHOWN BELOW OR AR�CM <br />LOT BIOCN OF <br />PRQIECT AUDHE55 <br />�-�I2� (5'tVt�u.`t [� <br />PLUMBIN6 <br />NO. TYPE OF FURURE <br />_ � WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWEfi <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFiINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />� SO l0 <br />'7`- <br />1.+� � � �1��� <br />OH ITEM FEE <br />i <br />r � _ <br />5 <br />� 70TAL <br />FOR OFFICE USE ONLY: <br />FflONTSETB�CK REARSETBACN <br />�20 ' 2�' <br />USEZ LOT�flEA <br />- ( r'J/o% <br />7VPE Of CON75. QlOW�BIE TVPE Of LON51. �CIOAL <br />SIZE OF BLD(3. I NO.OF <br />LOAO <br />INTAKE BV <br />FIRE SPRNKLERS REO'D <br />n(0 <br />PLANS APPROVEO Bv <br />�� �/2e <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED OY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIG^NAiUREOFCONTRACTORORAUTHORIZEDAGENT OATE �/��/�/ <br />/ \ <br />AND 6USINESS NMIE <br />FORCED AIR SYSTEMS-B.T.U. <br />UNIT HEATEiiS-B.T.U. M <br />- CLOTHESORYERS <br />( VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />3 O� - <br />$ -�- <br />$ �pi <br />SIUE SETBACN � � � _ � � _ < <br />S �� El'(fJwF�.> <br />VACANT SITE <br />No <br />p[(I1V,INCY NO OiOWiII�NGUNitS <br />cnav <br />R-3 � <br />6�SEMENT <br />�L._— <br />HEIGHT LIMITATION <br />�, <br />CITY OF EVERETT <br />auaniNe�� �y c�p� <br />PLUMBING <br />MECHANICAL <br />ADf11T10NAL PU1N CHECK <br />O7HEFi <br />STATE BUILOING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />M E.A. ' <br />� <br />i <br />� <br />T <br />� <br />� <br />� <br />SUBTOTAL $ / ^ <br />PERMIT $ � <br />TOTALFEE $ �� <br />/�:� 03 <br />FE �n �� PECEIF � ��� <br />J 5 <br />