Laserfiche WebLink
!�1 C��7 y <br />�i � r`ri <br />9 �x-3 cn <br />H 93 <br />y Z F-+ <br />FC C± <br />H xl <br />'�sJ H "sJ <br />V1 H <br />t7 O [�1 <br />H C7 <br />H t7 O <br />G] Y �] <br />9H� <br />� <br />rH� <br />pyH <br />O l7 C� <br />� � Cs7 <br />zHm <br />H O Cn <br />:. <� <br />APPI.BCATr�.� �'O� COtdSTRIJC'P�iJN ���RMIT <br />fhe Evergreen <br />CIN OF <br />�verett <br />BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION O COMBINATICi� ❑ BUILOING '� MECHANICAL <br />❑ PLUMBING <br />O\YNEfl j y IAPILA�DRESS ( (� ,GyIi�Y e� �J.y� [], <br />�_'ll'�-�11�[ IYI�..n(.�_..t.�Zl IJi%�1� " F1' ��1 �� �U�/ t`�/�/L._�:lil� /�10� <br />TENRNT MAILADDRESS CITY ZIP PHONE <br />� � // // <br />„-. i i <br />ARCNRECTORDESIGNEN MAILADDRE55 CITY ZIP PHONE <br />GENEPALCONTPACTOfl MAILADORE55 CITV ZIP PNONE LICEIJSEM <br />��1 v �.,-a � <br />_..r•_.'_..5. �.. ..��.�oecee CITY 21P PHONE ��CENSEt <br />PlUM81NOCONTflRCTOR MAIL <br />GITV <br />❑ NEW V❑ ADDITION ALTFRATION IJ REI'AIR C7 DEMOLITION ❑ WOODST <br />TENANTIMPflOVEMENTOflINTF�JilOR1iEM00ELONLY rl GONTACTPERSONPNOPNOI:E <br />n91 /'� i I <br />OF <br />LEGAL DE56HIPiloN or rnurcn i� �onvnn n=...i <br />LOT BIOCK OF <br />PflOJECTA0DRE55 <br />DRAIN <br />FRONTSE7BACN <br />USEZONE <br />TYPE OF CONSL AlLOV.'ABLE <br />S12E OF :�OG. <br />OCCUPANCYLOAO <br />REASON FOR SPPINKLEflS <br />APPUCATION ACC. DY <br />s <br />everett <br />� <br />❑ SIGN <br />INSERT ❑ BUILDING RELOCAT!ON <br />� �c�A� -S�E����vp,� S�.�i; auo 41o7s,: (_�+4s� <br />fi�� -^�- �'Y�f�'J.�i �, <br />1 HEREBY CEfiTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TFUE AND CORRECT..4LL <br />PROVISIONS OF LAWS AND OriDINANCES GOVERNING THIS TYPE OF <br />WOR!< WILL BE COMPLETED WITH WHETHER SPECIFIED I1EP,EIN Ofi <br />NOT. THF GRANTING OF P PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITI' TO VIOLATE OR CANCEL THE Pi;OVI510NS OF ANY <br />OTHEfl S7ATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTflACTORS LAW 7827 RCW AND 29u200 WAC. <br />SIGNATUREOFCONTRACi0ROF1�UTMORREOAGENT OATE <br />X �i1� . <br />Yil•]� <br />T <br />WATER HEATEH <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEATAUMP <br />FAN <br />SUB TOTAL S �_ <br />PERMIT 5 � <br />'TOTAL FEE 5 ' <br />REAf15ET9ACN SI�ESETO�CK PLANCHE/C;NNUMOEfl <br />y �� �� <br />LOTAREA VACANTSITE FEES <br />❑ YES ❑ NO pUILDING <br />iYPCOfCON57.ACiUAI ataruitr Na.o�ownunGuvns <br />cnouv pLUN01NG <br />NQOFSTOfiIES D�SEMENT ��EGHANICAL <br />CI YES ❑ NO <br />FIRE SPRNKLERS REO'0 HEIGHT LIIAl7ATION OTHER <br />U YES ❑ NO STATEBUILDINGSUHCHAFGE <br />STATE ENER6Y SURCHARGE <br />PLANSAFPROVEO BY CITY OF EVEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TO' <br />PERMIT <br />TOTALF <br />FEE <br />RECEIPT N0. <br />u <br />� <br />