Laserfiche WebLink
APPLICA'1��N FOR CONSTRUi:�fiON <br /> PERMIT <br /> f�e Ereryreen <br /> CITY OF �verctt <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEP AUI��DONESS GILY IIP PNOIIE <br /> � �72z Cvz��r GJvr 9szo / <br /> TEN�N�� M�ILII0DPE59 CITY 21P P110NE <br /> j ANCMiTEGtONDEb10NER M�IL�ODREb9 G1Y ZIP PHONE <br /> OENEMLLONiR�10B M�iUDDREBB CIIY IiP RION[ IIGU�9E• <br /> ME�N�N�C�I.CANiNeC10N MAILAOOPE59 GiY ZIP VMONE UG[NSE• <br /> ��xA �rw� Sfr�rr .�+-r 3/�/ /�rr < v rrr 9P o� 25-z 3i/¢ E�"vc�bssiLlL'� <br /> i2VMe�HOCOntaecron / 1MILADDPESS COY ZIP PNONE LiCENSE• <br /> C1A550f WOPK <br /> ❑ NEW ❑ AODIiION ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILOINORELOCA710N <br /> TEN+.NT IMPROVEMEM OR INIERIOR REMODEL ONLY ('pNi�tT PEHSON�NO PHONE NO <br /> fONTRAGT f�NICE O�WOIiK <br /> pFBCRIBE WORN�ND SOUApE FOOUGE INVOlVEO <br /> � 4cT <br /> PNOP09EDUSEOFOUiLD 0 <br /> D�^,� I HEREBY CERiIFY THA7 I HAVE REAO AND E%AMINED THIS APPLICATION AND <br /> t ! KNOWTNESAMETOOFTRUEANOCORPECT.ALlPRO'JISIONSOFLAWSAND <br /> LEO�LD[SCRIPiIONUFPPOPENTYISNOWNOELOWORI�TT�CNfOURGOPlE9� ORDINANCESGOVERNINGTHISTVPEOFWORHWILLBECOMPLETEDWITH <br /> W HETIiEfi SPECIFIED I1LR[IN OR NOT.7HE GRANTING OF R PERMIT DOES NOT <br /> PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCE�TI1E PROVISIONS OF <br /> �oi etot� oF ANVOTHERSTATflOBLOCALLAWREGULATINGCONSiRUCT10NORTHEPER• <br /> FORMANCE OF CONSTRUCilO1J.THAT 1 AM AUTNORIZED�Y THE O'NNER OF <br /> THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLIC�TION�5 MADE <br /> I AND I COMPLY WITH iHE bTAIE CONiRAGTORB lNW 18.Y7 RCW AND <br /> 290.200 WAC. <br /> � 610N�lUPEOF�ONiRFCtOPORpU1110RREDAOCNf DAIE <br /> iPPOJEG7�DORESS API�LIC�ryTS�!�SENO.�ESSN�ME Z— / / � `� 1 <br /> Z 22 Co�. <br /> I PLUMBINO MECHANIC�L <br /> I NO. TYPE OF FIXNRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE I <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> IBATHTUB _ FORCED AIN SVSTEMS—BT.U. M EA <br /> � LAVATORY(WASHBASIM UNITHEATERS—B.T.V. M <br /> iSHOWER _ CLO7HES ORYEtiS _ <br /> KITCH EN SINK 6 UISP. VENTILATION FAN <br /> I DISHWASHER RANGEHOOD <br /> � LAUNDRYTRAV WATERHEATEFi <br /> 1 CLOTHES WASHER WO00 STOVE _ _ <br /> UR�NAL METAL FIREPLACE d CHIMNEV <br /> � DRINNINGFOUNTAIN FIREPLACEINSERT <br /> � FLOOF OFiAIN HEA7 PU�tP <br /> i BACKFLOWPREVENTERS GASPIPINO <br /> ROOF DI7AIN5—RAINLEADERS E%HAUST FAN <br /> � SINK�SERVICE—BAR,ETC.) . <br /> I — <br /> � <br /> � — <br /> i <br /> � SUBTOTAL S SUBTOiAL S <br /> ; PERMIT S PEiiMIT S � <br /> i TOTAL FEE S TOTAL FEE S " <br /> I fRONiS[1B�CK pEAR6Et0AGN SIpESETB/�LH PUINtNECNNUMBER FEE RECEIPTNO. <br /> I <br /> � USEioNc �otenFw V�GNTSIIE FEES VALUATION FEE <br /> O VE9 ❑NO <br /> � BUILDIN6 <br /> � TYI'EOFCqN9i. OGCVPANGYOPOUP NO.OFOWEtLIN0UN1T9 <br /> � AIlOWn8LH11CfU�L <br /> PLUMBINO <br /> BIiEOFeL�O. NO.OFSTORiES BSMT. OLGIO�D �' <br /> o r MEGHANICAI <br /> ON <br /> HEIOHIIIMIt�T10N OTHER <br /> FIPEBPRINKLERSREOUTAED O YE9 O NO STATE BUILOINO SURCHARGE <br />' � STATE ENEFiOY SURCN.4RGE <br />, MPLILATION ACF DY iLAN9 APPR BY <br /> PUBLIC WORKS <br /> TOTAL 3 <br />