Laserfiche WebLink
IN EwrprNn <br />cin oF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />�c�.� ��i �•.�f•.� <br />,-.PPLICATION FO`. <br />CONSTF��JCTION <br />PERMIT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />everetl <br />e <br />❑ DEMOLITION ❑ COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />p�yqEp M�RADORE55 C1iY ZIP PHONE � <br />'3NE �+x_ �+4oP 140� �,C 6v�scrt�d�c. t-1�6`( <br />4HCMItECTOHDF510NER MRIL�OpPE55 GITY 21P PMONE <br />�7G�/1 �.1 C�cd�icX_ 70l D6ttEC /atii �.l �e15 �J6MtTt—E_ R6lo �i Z.B �— 52t+<j' <br />[iENEN�LCONiq�CIOF MnILA0�NE55 CItY ZiP o��ONE 4CENSE• <br />Gtyp C�t,.�c�r.e�.t �R.cs�p 70l nc,.. �-Ll2 �c6 9Bco'( �8d. �+srasf5 <br />MECH�NiWLCONiP�GTOq Mr11LA0DRE55 Glrv ZiP PNONE � LICENSE• <br />.�— �i�0 C��T �SCCa <br />PLUMBINGCUVTP�G�OR MNILAODRE55 CIfY 21P PHONE LICENSE � <br />Y� <br />GLASS OF �YORR d <br />❑ NEW ❑ ADDIT�ON Ky.ALTERATION ❑ REPAIR ❑ DEMOL�TION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />V�W�TIGN OF WONK ICOST OF MATEPIPLS PW$ IPBOHI i <br />2� G�% � <br />oescnieewo K - '. <br />USE <br />OF <br />io�_ <br />PI.UMBING <br />TYPE OF FIXTUNE OR ITEM <br />WATER CLOSET (TOILET� <br />BATNTUB <br />LAVATORVIWASH BASIN� <br />SHOWER <br />NITCMEN SINK d DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASMER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN ' <br />BACKFLOW PREVENTERS <br />ROOF ORAINS — RA�NLEAOERS <br />SINK (SERVICE — BAR, ETC.) <br />NT SETB�:k <br />ZONE <br />o��+� - <br />ov e�oa. <br />795 JF <br />TOTAL <br />FEE <br />ores <br />IIPANGYGPOUP NO.OF <br />f.3 - Z <br />OF STOPIES <br />/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS AP• <br />PLICATION AND KNOW THE SAMETO BE TRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETECI WITH WHE"fHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFl, PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. . <br />SIGNATURE OF CONiRACTOR OF AUiHOFIZEU AGENT OATE <br />MECHAMICAL <br />FEE NO. TYPE OFEQUIPME <br />A/C —A/liNDLG UNITS — H.P. <br />REFRIGERATION UNIT$ — H.P. EA. <br />BOILEP.S — B.T.U./FI.P. <br />GnS FIFED n.C. UNITS — B.7.U. <br />FORCE� AIR SYSTEMS — B.T.U. <br />WALL HEATEPS — B.T.U. <br />UNIT NEATERS — B.T.U. <br />EVAPOflATIVE COOLERS <br />CLOTHESORVERS <br />VENTIIATION FAN <br />HANGEHOOD <br />. WATER HEATER <br />wOO�STOVE � <br />MEfAL FIR'cPLACE d CHIMNEY <br />� <br />/�' <br />Rf10NACG.Bv p�ANSCMECKEDBY AFFR.F�RISSUANCEBY <br />�/4 � /�,(,�i <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CM CN NUMBER <br />vg I � �� � <br />FEES <br />BUILDING — <br />PLUMBING <br />MECHANICAL <br />SUBTOTAL <br />PlpMIT <br />TOTALFEE <br />FEE <br />I �� <br />VALU <br />$ 7A <br />OTHER <br />STATE BUILDING SUHCHARG <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA. <br />M <br />M <br />�� I HECEIPT NO. <br />n �� <br />PRO�ERN OWNERS ARE RESPONSI@LE FOR DETERMININCa ALL <br />PROPERN LINE LOCATIONS AND RELATEU EASEMENTS. <br />