Laserfiche WebLink
,-. <br /> � <br /> APPLICATIOhi FOR CONSTRUCTIt�N PERNIIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 • (425)257-8810 <br /> ❑ DEMOLITION O COMBINAI'10�{�,��'] BUILDI Et1 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: IIZLIo a^�b°��—�+— ` "`�`" �� �� ���� <br /> Kiv. u.to C: pp�I5f Y1v ��fh�S� (,—v�Piu�� g:fW� ��Lf ' ' ) .r��- <br /> O ER ����`�� � � ��e/l�y � 1 Tl�- 34�' Dr S�'ry CW"�IP /�rvi PHONE � K/1 / �� ) V r V � <br /> �/vI <br /> 7EN�NT M/UL�DOFF.55 dTY 21P PNONE <br /> K;„y � �Po �3 �u�� 3 .�.� W� 1'���P (�G ) /�3 G ! 6 z <br /> �RCHRFCTORDES�GNER MMLAUOFE55 CITY ZIP PNOhE /�'I,� <br /> M��.c. �h,.�:-y 9� S v�-� s�- �-� w+� 5�'«� �io6) 7G3 d i G 1 <br /> GENEO�LCONTRACTOR M�ILADDRE55 CI7Y "IP PNONE SG�ELICENSE� <br /> _�gp�d,►-�. ,.� �k<+Aee�.2� �� ��w �z"�"s Ke�r 9��L �s> �r�- sylv <br /> MECHIWIC�LGONTRACTOR MML�W�7E55 Cltt ZI. PHONk STATFUCENSEt <br /> PLUMBINGCONTPAf,TOR M�ILADORES$ GI7Y l�� PHONE ST�TEUCENSE� <br /> CpNTMCi PRILE OF WORK * HEATING SYSTEM: ❑GAS � ELECTRIC ❑ <br /> L�,o170 �— <br /> DESCRIBE WOHN�NO SOW RE FOOTMaE INVOLYEO CONTRCT PERSON�PHONE NO ��'G 7� L/ � <br /> S d �� " � <br /> t h � <br /> Sr � � /� � . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �y,,,,� b �i/ln+^^. ApPLiCATION AND KNOW THE SAME TO BE TRUE AND CORRECT AI.L <br /> � v SED USE OF BU'LDINO �}., pqOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � (��^''�yr WORK WILL BE COMPLIED W�TH WHETHER SPECIFIED HERE�N OR <br /> LEC�L DESCRIPTION OF PROPERTY(SMOWN BELOW Of1AT7ACH TWO COPoES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> `oT�eL�K�pF ✓„.�, AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAI LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PMCEI TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ¢4zy. ov �-ov3_ 0�-� 3 ���.,�,(ti„ �- y� <br /> �o-� <br /> CONSTRIILTION LO�N�ENDER,hWRE55.TELEPMONE NUMBER � DATE <br /> SIGNATURE <br /> �ITY BUSINE55 LICENSE ND <br /> PWMBING MECHANICAL � <br /> NO. TVPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPM � FEE <br /> WATER CLOSET(TOILEn � A/C—AMNULG UNfTS � � <br /> BATHTUB ; FORCED AiR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP —� ' <br /> � UNIT HEATEFS � <br /> SH WER � <br /> KIT EN SINK 6 DISP � i CLUTHES DRVERS ' <br /> i RANGEHOOD ' <br /> DISH HER � WATER HEATER � <br /> LAUNDR RAY � <br /> CLOTHES HER � WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> � <br /> DRINKINC�FOUNTA FIREPLACE INSERT(WOOD BURNING) � <br /> i <br /> � GAS F�REPLACE � <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE-BAR,ETC.) � GAS PIPING ' <br /> � EXHAUSTFAN � <br /> � <br /> � <br /> i <br /> � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL 5 � <br /> PERMIT $ � PERMIT E <br /> TOTAL FEE E � TOTAL FEE S _ �/0 ' <br /> FOR OFFICE USE ONLY: aecemrNo <br /> FFONT SFTflRCN REAR$ETBACK SIDE$ETB�CK �UNCIIECK NUMflF.R <br /> IEF <br /> ` EES VAIUATION FEE <br /> USE ZONF 1 O7 AREA V�CANT SIiE __ -- (�[�/� <br /> ❑VES ❑ NO 9UIlDING Q(/u' SD �S7 <br /> MEIGHi I IMIT�TION NO.OF DWELLING $IZE Oi BLDGRI � <br /> UNIi$ (Q/(y�� �/ FIUM9ING ____ �^� <br /> I'/U ' '_/__ <br /> OGCl1PANCY NO 0�$InalE$ O(:CUP�Ni LOnD BASfMENI MFCHnNlf,nl ID 'w__ <br /> f.ROUF � ❑YES ❑NO ------ <br /> U <br /> FDDIIIONnI.�tAN C11(.f.K ��! <br /> FIRESPFINKLERREO'D �FASON — <br /> AlU o,��E� ;— <br /> PIREAIl���dREO'� RFASpV SIR1FAlI1lU��lGSU�CII�RFE <br /> —L�'C 'l <br /> NO _ -- — _- <br /> IYPF.Off,ONST PL�NSAPPPOVEDBY CITYOFEVERETT runnr.wo���s _ ___;_�_ <br /> IOCAL SALES /� �;�_� <br /> � on*a IO $U `�7 TAX CODE IS 3105 TOTA� <br />