Laserfiche WebLink
c�'1 �", <br />APPLIC:+�ION FOR CONSTRl.�T10N <br />PERMIT <br />Ihe Evergreon everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN INK— Pi.FASE PRINT <br />OWNER MAILFODRE55 GITY ZIP PMONE <br />TENRNT MFILA�OFE55 CITY ZIP PHONE <br />['�as� rneKlS�� 4ao Sc EvPv_aT.-ri����.,� Ever�r'r_ <br />AHCHITECTON�ESIGNER MqILADOPE55 CITY ZIP PHONE <br />GENEIiFLCONTRACTOR MAILADOflE55 CITV ZIP PHONE IICENSE• <br />�v�hM LS QKTI�LNHefd �yLl4[�T�P.v�S� SRA��(�/r. 981�4 �`l�-9815�(��(L�afiGd�4�d1 <br />MECHANICALGONTpACTOF MRILA�DBE55 iY ZIP PHONE LiCENSE• <br />PLUMBINGCONTflACTOR MFIlA0DRE55 CITY ZIP PNONE LIGENSE� <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUIL�ING RELOCATION <br />e�G 2 BL.v�si�µs <br />LOT BLOCN OF <br />�l 3 0 s� � � e�e�d �ia �/ �,� In� <br />PLUMBING <br />NO. TYPE OF FIXTURE OH ITEM FEE <br />WATER CLOSET�?OILE� <br />BATHTUB <br />LAVATORYIWASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER _ <br />URINAL <br />URINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS— RAINLEADERS <br />SINK (SERVICE — BAR. ETC.) <br />SUBTOTAL S <br />PERMIT S <br />TOTAL�EE S <br />IONTSETBRCH REAFSEfOACK SIOESETBACH <br />ttPEOFCON� ' <br />ALLOWABLE/ACTUFI <br />❑Y <br />❑N <br />FIRESPRINI(LERSREOUIFE� O YES ❑ NO <br />❑ YES ❑ NO <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AN� CORREGT. ALl PROVISIONS OF LAWS AN� <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />WHEfHER SPECIFIED HEREIN OR NOT.THEGRANTINGOFAPEF.MITDOES NOT <br />PRESUME TO GIVE AUTHORIlY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER- <br />F7RMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 pGW AND <br />296200 WAC. <br />SIGNATUPEOFCONTRACTOROFFU�IIOR2EDAGENT OATE �/89 <br />X ���� �3�f��f� / <br />AP I ANTS VBUSINESSLIGENSENO.ANOBUSINESSNAME <br />MECNANICAL <br />NO. <br />NC—A/HNDLG UNITS— H.P. <br />FOFiCED AIR SYSTEMS— 6T.U. <br />UNIT HEATERS— E.T.U. M <br />VENTILATION F/ <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE 7 <br />FIREPLACEINSERT <br />fiEAT PUMP <br />EKHAUSTFAN <br />BUILDING <br />PLUM9ING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />�TATE ENERGY SURCHAFGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT <br />TOTAL FEE <br />VALUATION <br />5 <br />FEE <br />