Laserfiche WebLink
--� -- <br />APPLICATI4.i FOR CONSTRUC7.JN PERNAIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />l�l SIGN <br />n nFuni irieN n COMBINATION �c' BUILDING I� MECHA►dCAL n PLUMBING <br />)YM�ER" MA�IL/A�DDf1ES5 ���T <br />�T/,Q/S ,SK%%O N • 'S'O'�7 OJG�E <br />fEN�NT MPILAUDRESS ��T�' <br />,�au,� ,Q 7�ri�y 7ss .Se�rN Eu6e.E QA <br />ARCNITECTORDESIGNER MAILAD�RESS CITV <br />4u7,taU7�c �tsXi,o� N�+�s. 7ss S. ENGGE � <br />GENERALCONTPACTOR MAILADDPE55 CITY <br />�� �� <br />MECHANICAICONTRACTOR MAILADDRE55 CITY <br />PLUMBINGCONTRACTOR MnILADDRE55 ��T�' <br />�' .� f GUD ��% 3�/a <br />CONTMCT PRICE OF WORN <br />DESCRIBE WORK AND SOUARE FOOT E INVOLYEO � <br />Add.i ai- o� // k/6 Tu ruA�c c <br />S�� revr� � .l��i� �rn�, ��c <br />.�DO sp �'7 <br />PROPOSEC USE OF BUILDINO -y- n <br />S. T _ K . <br />toT .3 � eiocK _ <br />SE�. .sS. %wP. <br />FlELOW ON <br />/�/ Q6E <br />i3� • UOo ' 0.3c.� -( ct7:� <br />LO�N LENDER. ��DRESS. TEIEPHONE NUMBER <br />NO. TYPE OF FlXTURE OR <br />'NATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />URINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SEFVICE — BAR, E1 <br />COPIES) <br />SUB TOTAL b <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FqpryT SETB�CN RERR SETBACN <br />ZS� 25 <br />USEZONE LOTAREA �7 <br />�� � I J\ <br />HEIGHTLI�MIpTAT�ON UNITSD IELIJNG <br />LO <br />OCCUPANCY NOOFSIOPIES OCCVPRNTLOAO <br />ND <br />DF CON! <br />� <br />DATE <br />S�DE SECTB,CK <br />1 J 'h' 7. 5 <br />VACANT SITE � <br />XNO <br />PXONE <br />57. <br />21P <br />/ <br />t� , 9823 Y 67 Y-'/ <br />zm PHONE � 3 9 <br />IJA, 9�z39 6�4�b AuiHEI-7zSP0 <br />21P PNONE STATE IICENSE � <br />21P PHONE STAiE LICENSE � <br />PHCNE <br />HEATWG SYSTEM: IY.IGAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO. <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br />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 />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />�ti �� c �w�. Y��495 <br />TURE D�TE <br />CITY BUSINESS LICENSE NO. <br />NO. TYPE OF FlXTURE OR ITEM FEE <br />A/C —NFiNDIG UNITS — H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNINGi <br />FlREPLACE INSERT (WOOD BURNING) <br />GAS <br />GAS <br />SUB TOTAL S <br />PERMIT S <br />TOTAIFEE S <br />NpEq FEE RE6EIPTNO. <br />� � /G� � O ////3/ <br />f7VE5 � BUILDING <br />512E OF BLDGRI. <br />�� � ,�ol t PLUM�ING <br />/3'rIt Iv <br />BASEMENi MECIIANICAL <br />❑YES �NO <br />AODITIONAL PIAN CMECK <br />OTHER <br />STATE OUILUING SUPCHARGE <br />CITY OF EVERETT ruoucwonKs <br />LOCALSALES <br />TAX CODE IS 3105 7o7AL <br />0 <br />