Laserfiche WebLink
i <br /> � r <br /> APPLICATII..� FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINAI'•ON fF9. BUILDING ❑ MECHANICAL I-1 PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> 5i�3 �3 F o�t c.=.r T A�e . <br /> OWNER MAILAODRESS Cltt ZIP PHONE <br /> - /�'1h2K G L L.�J '1SD3 F�re�r p„ �ve�c1'fi �lSxo3 z�5-r9vi� <br /> �ENPNT MAILADDRESS GITV ZIP PHONE <br /> J".4.�-c E <br /> ARCHITECT OR DESIGNEF MPILAD�RE55 CIN ZIP PHONE <br /> Dhvrq t/1i✓ /2.so7 .v-c.- /y/-'" G✓cy /��rk/N,..( 5'�bo.l�r d��.o �5.z� <br /> GENERALCONTRFCTGR MAILAOORESS CITV 21P PHONE STATELICENSEM <br /> . '' I�Ne� .'J 4/K f✓ <br /> MECHANICALCONTRACTOR MAILADURE55 CIN ZIP PHONE STATELICENSE� � <br /> � PLUMBING CONTRRCTOR MRILADDRESS CIN ZIP PHONE STATE UCENSE� <br /> CONTRACT PRICE OF WORK � �/ <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br /> DESCRpIBE WORN AND SOUqRE FOOTA�E INVOLVE� fy�OYa� Ziy[5/0� CONTACT PERSON ANO PHONE NO. <br /> ll p J�e /G L—.G L1 S ]-. S`/ —.5— o r3 <br /> Ttt S , Fr A ro /7/6 � <br /> I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIL� c APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> '' �f 4• � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> /[ �a��oEs IPTIONOFPROPER (SHOWNBELOWORRTf CHTWOCOPIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 7° �or �r e�ocK '%v� D-cooF Fe.-ert Pa.k ��{�,(�, AUTHORITY TO VIOLATE OR CANCEL THE FROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINCi CONSTRUCTION OR THE <br /> L' �2�^Gf'f' Uj V. I�' 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 /> � d PAflCELTAX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ,q° Hv9s= aoo-ozr-voos" <br /> CONSiAUCTON LOAN IENDER.A�DRESS.TELEPXONE NOMBER x �?'« ����_ ��Z� �J S <br /> � SIGNATU DATE <br /> i <br /> . CITV BUSINE55 LICENSE NO. - <br /> � PLUMBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP i <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK&DISP i CLOTHES DRYERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � � � <br /> URINAL � WOOD STOVE ' <br /> DRINKIN6 FOUNTAIN ; METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRA�N � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVE�TERS ; GAS FIREPLACE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> GAS PIPING ' <br /> i EXHAUST FAN i <br /> � i <br /> i i <br /> _ i � <br /> _ i � <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT $ � PEfiMIT $ i <br /> TOTALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: �/ <br /> . FRONTSE7BACN� REARSEfBACK SIOESETBACK PLANCHEC NUMBER FEE RECEIPT O <br /> zo ?o� ��,�� s �4�9 �23�Z <br /> use zoN LOTAREA VACANT SITE FEES VALUATION FEE <br /> �—� .,, pp nves rrFo euaowc 2`/ 583 2 <br /> HEIGHT LIMITATIGN NO.OF�WELLING SIZE OF BLOGRI. � <br /> �7m� �F UNITS "'� SL �D PWMBING T <br /> `U C <br /> OCCUPANCY NOAFSi0PIE5 OCCUPANTLOAO 045EMENT MECMANICAI ~ <br /> GRQ�- � � //Y <br /> �+� ❑YES NO � <br /> FIREAURMREO'D qEA50N A�UITIONALPLANCHECK � <br /> 0 OTHER i <br /> FIRE SPRINKLER REO'D REASON i <br /> � STATE BUILDING SURCNAflGE � ) <br /> iVPEOFCONST. PLANSAPPOVFDBY CITYOFEVERETT PUBLICWORKS � <br /> jv LOCAL SALES <br /> ]r� DATE 9 — TAX CODE IS 3105 TO7AL 2 ; <br />