Laserfiche WebLink
....n.e .a�La. . . ..._� ...,.... .v. .... . ..... .._v ..�._...�...., . .,.. i. . . .t� .� ... ..L' .._. .. ... .._.__ � . ., :/. .. c_'" �._i'�C.r.. <br /> AP�LICAr10N FOR COFIS7RUt�:TION <br /> P�RMIT <br /> rhe Evergreen <br /> CITY OF evercll <br /> everett e <br /> BUILDING DEPARTMENT <br /> 259•8810 TO EE COMPLETED IN INK— PLEASE PRINT <br /> OWNER IARILA�DPES$ L�I j7(� GIIY ZIP P110t1E <br /> �c o,� rh - o�� '�3sv[n/,�-,Er, o �v'�e_y��. 5�/U�f 38G�-s�iy- <br /> TENANT MAILAOOFE55 CiIV ZIP PNOf1E <br /> AlICHIfEGTO0�E51GNEB MAILAO�fiESS GiiY ZIP PHONE <br /> GENER�LCONTRACTOR MAILeDDRESS CRY ZIP PNOdE LICENSE• <br /> MEGNANICALCANTPACT08 IAAILA�DPE55 CITY ZiP PMONE LICENSE• <br /> PLUMBIiJOCONTflAC10R IA�Il�00RE55 GIiY 21P PMONE LICENSE• <br /> I�LUm3l�lv CUN[�:�T sSvo / 'YFur.r S Ser� d+/r�, 5�/�8 ��z-S}Zy i�LUmBC �t <br /> GL�SS OF WORK ��.��Z <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVUFRPLINSERT ❑ BUILOINGRELOCATIOIJ <br /> IEN�NTIMPROVEMENTOflINiER10HPE1dODElONLY CGNiACiPE050NRNDPHON[N0. <br /> fANTNAGT PqICE OF WOFK <br /> DESCNIBE WOHKAND SOUAFE i00TAGE INVOLVED <br /> -T ; -m �n�T <br /> rnovoeeo use oF euuowc I HEREDY CERTIFY 7HAT I HAVE READ AN D EXAMINED TH IS APPLICATION AN D <br /> KNOV!TI1E SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LAWS AN D <br /> LEG�LpEStNIPfIONOFPflOPERiY�SHOWNOEIMYOPATiAC11FOMGOPIES) ORDINANCESGOVEfiNINGTHISNPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHERSPECIFIED HEREINOR NOT.THEGRANTING OFAPERMITOOES NOT <br /> PRESUME TO GIVE AUThIORIN TO VIOLATE OR CANCEL 7HE PROVISIONS OF <br /> �oi o�ocK oF ANYOTHEFiSTAT[ORLOCALLNWREGULATINGCONSTRUCTIONORTHEPER� <br /> FORMANCE OF CONSTRUCTION.THH7I AM AUTHORIZED BYTHE OWNER OF <br /> THIS PROPERN TO PERfORM THE WORK fOR WHICH APPLICATION IS MADE <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br /> 2�J6.200 WAC. <br /> � SIGNRNREO'CON ncronoen REDRG[ �PTE <br /> / <br /> PPOJECTADOPE55 � d ITY�1/9N � .E�NDOUSINESSIlAME `�� <br /> � ' �'vcr � l.✓ `� <br /> PLUM9ING MECHANICAL <br /> NO. TVPE OF FI%TUflE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSEf(TOILEn A/C—A/HNOL 3 UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. IA EA <br /> LAVATOFY(WASH BASIN) JNIT HEATERS—&T.U. M <br /> SHOWER CLOTHESDf7YER5 <br /> KITCHEN SINKB DISP. V[NTILATION FAN <br /> DISHVJASHER RANGE HOOD <br /> LAUNDRYTRAY _L WATERHEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSE(iT <br /> FLqOR DRAIN HEAT PUMP <br /> BACKFIOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEAD[FS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC) <br /> SUBTOTAL 5 SUBTOTAL 5 <br /> PERMIT S PERMIT S <br /> TOTAL FEE 5 TOTFL FEE 5 <br /> FFONTSETBACK pEPP5E19ACK SIpESET�ACK PLANLNECKNUMOEfl FEE NECEIPfNO. <br /> uSeioNe �oinnen VACANTSITE FEES VALUATION FEE <br /> ❑YES ❑NO — <br /> TYPEOFCONST. OCCIIPPNCYGPOUP NOOFOWELLINOUNITS BUILDING _ <br /> ALlOWAOLE/AGTWI <br /> PLUMBING <br /> SIZEOFOLOG. NO.OFStORILS U51AT. OGGLOAO <br /> n v MECHANICAL <br /> ❑ N - <br /> ❑EIGHTLRdITATION OTHEF7 <br /> FIRE SPRINNLEfl5RE0UIFED ❑YES ❑�!O STATE k3UILDING SURCHARGE <br /> STATE ENERGY SURCHARGE <br /> APPUCRTIONRCCBY PLANSAPPIi.BY <br /> aueuc woaKs <br /> TOTAL <br />