Laserfiche WebLink
APPLICATI4A FOR CONSTRUC7 .vN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING [�"MECHANICAL ❑ PLUMBING ❑ SIGN <br /> `�PROJECT ADDRESS: � <br /> y � ' <br /> � G�K 7 <br /> 01KIER MMLADDRE55 Qtt SiP PNONE <br /> TENNlT MAILADdiE55 CITY ZIP PIIONE <br /> �RCMTECTORDES�GNER M�Il11DORE55 Gltt 71P PNONE <br /> GENER/LLCONTR�CTOR M�ILADpRE55 CIIY I�P PIIONE SGTEUCENSE� <br /> �1�11Y1{�� �CiYLlO <br /> MECH�NIGILCONTRACTOR MAIIADDRE55 Cltt ZIP PIIONE STATELICENSE� � <br /> MUAlING CONTR�CTOR M�IUOIXiE55 Cltt IIP PNONE STATE LICENSE• <br /> .�CONTRkT PPoCE OF WORI( � ��� <br /> HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> .y UESGRIBE WORK• $pU�pE F TK'iE INVOIVED GONI�CT P[q50N�NO PHONE Np <br /> '1" G Q � <br /> I - 'y �, <br /> • � � � �� I HEflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> seo use F BUILdI G APPLICATION AND KN01V THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> p �-�� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGIILOESCPoPTIONpFPROPEflT'ISIMJWNBELOWpqATTACHTWpCOPIES) NOT. THE ORANTIN6 OF A PERMIT DOES NOT PpESUME TO GIVE <br /> ior aiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> O7HER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �MqCEI TN!I.D.NUMBER CONTRACTORS/JL/AW 18.27 RCW AND 296.200 WAC. <br /> CONS7IKICTqNLOIWLENOER.11Dq1ESS.TEtEP110NEMlMBER �C1�G/e����/3�/G�/✓ ` IO1/I� 1 (� <br /> IGNATURE � D�IE <br /> CITY BUSINESS IICENS[NO <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYpE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—MHNDLG UNITS � <br /> BATHTUB ; FOFCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUTAP � ' <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DHVERS ; <br /> DISHWASHER � RANGE HOOD � <br /> UUNORV TRAY � WATER HEATER _� <br /> CLOTHES WASHER � WOODSTOVE , � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) ; <br /> Fl.WR DRAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTERS ' GAS RANGE � <br /> ' i <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING , <br /> ' EXHAUST FAN <br /> _ ' <br /> � � <br /> � , <br /> � � <br /> � , <br /> T— <br /> SUB TOTAL S ' SUB TOTAL f ' <br /> _ PERMIT s � PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> iqONT SFTflACK REM SETBACI( SIDE SETB�CN PUN CIIECR NUMflER :FF RF.f.EIPI NO <br /> USE ZONE �pi AfiEA VACANT SII[ FEES VAlUAT10N FEE <br /> ❑YE$ ❑ NO OWlI11N6 � <br /> i <br /> i <br /> M IG LIMITATION NO OF DWELLING SIZE OF BIDGR 1 •- � <br /> UNIIS <br /> P1U401NG <br /> OCCUP/J1CY NO Ot 51(NtlES OCCUPANT LO�D � <br /> G�P BASEMENT MECN�NICAI. � <br /> DYES ❑ NO - � <br /> FIRESPPINKL[(IREO'D BF.�SON aODIIIONALPUNCIICCR � <br /> �__ <br /> OillEti � <br /> FIREAV3iMRE0'D RE�SpN <br /> STqE OUIlDIN6$IIRCIU(16E <br /> iYPEOFf,pNST PL�NS�PPIlOVEOBY CITYOFEVERtTT ruonr,won�s '� <br /> LOCAL SALES — --�--- <br /> oe+e TAl( CODE IS 9105 70TAL ;' <br />