Laserfiche WebLink
rti r— <br />APPLICATI�vN FOR CONSTRUCti 10N PERMIT� <br />(:I fY OF EVERETT • BUILDING DIVISION <br />3200 CcDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION � MBINATIO �/�LDI� / �M�� ��P�LUM8ING ❑ SIGN <br />PROJECT ADDHESS: Q� S� �U � L Iy �� J <br />�OOf1E55 .�s cln , br <br />. �� <br />P1U401NGCONTRAGTOR M�ILADORESS CItY 71P PIqNE STAIELICENSE� <br />COf1TMGT VIUCE 0F YIORN � <br />/ S�'�� --- HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />DESCRIBE WJRI( �NO $OU�RE FOOT�U[ INVOLVED COIII�CT PCfi50N�HD 1'MONE NO �� � �� <br />C � v K�,/'�H�E�-n�fl/ <br />vnoroseo use or awidra <br />LEG�L OESCPIPTION Oi PRd'ERTY (�� �IOW 011 �TT�LH TWI <br />wT aiocK or <br />PMCEL Tl1%ID. MIYBER �,,, `^ �DD� ��� <br />�� ) <br />CONSiRVLT10N IO�N LENDEN. �OOaE55. TELEPMONE NUMBEfi <br />PLUMBINl: <br />NO. TYPE OF FlXTURE OH ITEM <br />WATE9 CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DIS�' <br />DISHWASNER <br />UUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PAEVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />I <br />SUBTOTAL S <br />PERMIT f <br />FOR OFFICE USE ONLY: <br />GRONTSETB�CI( REARS <br />USE <br />IOI�RE� <br />HEIGIIT LIMIUTION NO OL DWELLIH6 <br />UNIIG <br />OCCUF�NCY NO 0�51(wiFS OLCUP�NIl0A0 <br />1YPE OF <br />tlf �SON <br />o�rE <br />S�DE SETB�CK <br />VAC�NISI�E <br />❑YES ❑ NO <br />52E0lBLOORI <br />❑vE5 O NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />ACpLICATION AND NNOW THE SAME TO BE TRUE �1ND COiiRECT ALL <br />PROViSIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHEF SPEGftED HEREIN OR <br />NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHEH STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMAN�E OF CONSTR TION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS P O FORM THE WORK FOR WHI:H <br />APPIICATION M I COMPLV WITH THE STATE <br />CONTRAC S L 1 W AN 296200 WAC. <br />X � l � <br />SIGN�TUIIE 0� E ' <br />CI!Y BUSINF.551ICENSC NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMEHi FEE <br />FORCED AIR <br />HEAT PUMP <br />WATER HEATEH <br />WOODSTOVE <br />MEIAL FIREPLACE <br />CH:�9 <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE f <br />ri�Hc��ecKNuuern �rEF �nEr.FirrNo <br />pUIl01NC - <br />MII4pMG <br />NLf,11�N1C.�1 <br />�OfN I ION�I PI AN Cnf f.N <br />O�i�En <br />$I�IE 01111[HN65�InC�U00F <br />runi ir, wonas <br />TOTAL <br />