Laserfiche WebLink
APPLICATIOrI FOR CONSTRUCTION PERMIT <br /> CITY OF EVERETT• BUILDING DiVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-88t0 <br /> fl DEMOLITION fl COMBINATION fl BUILDING MECHANICAL rl PLUMBING fl SIGN <br /> PROJECT ADDRESS <br /> O� .fCL�O T uJ.4 f,/ �£.-T 9�zo...? <br /> OWNER MAI�AODRE55 CIN 21P PHONL <br /> � �C, O L��o�/ �/D� EC'c inT w.v si fd: S'�'eo� <br /> TENANT MAILApDRF55 CITY 21P PHONE <br /> ARCHIT[CTOR�ESIGNER MAl1.ADDRE55 CITV )IP PMONE <br /> GENERAICONiRAC10R MRILpDDf1E55 CI7Y ZIP PIIONG SIATEUCBNSE• <br /> MECNANICAL CONTRACTO7R MA�ADDRESS CIN JIP PIIONE STqTE LICENSE� <br /> � � —l� <br /> PLUMBINGCON7RpGTOR MAIIADDRESS CITY 21P PHONE SfqTEIICENSE� <br /> CONTR�CTCRICE OF WORN <br /> '�3. 33. �8 HEATING SYSTEM: I '�,AS �l ELECTRIC �l <br /> DESCRIBE WORK AN�SOUARE FOOTAGE INVOLVED CONTRCT PERSON AN�PIIONE NO. <br /> D u�— oe c O /�FRT/•✓C <br /> o G/a L �,o yc <br /> �CCCTYIC �/.J ���,e y � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROi'OS SE OF BUILUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECr ALL <br /> E' PROVISIONS OF LAWS AND ORDINANCES GOVERNING TIiIS T`�r�E OF <br /> LEf.A�OESCRIPTIIXJOFPROPERtt�SHOWNBELOWORATTRCHTWOCOPIES) WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT t 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 /> PARCEL iN(ID.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENUER.A�URESS.TELEPHONE NUMBER ��'Z��SS <br /> SIGNATURE � DATE <br /> CITY BUSINE55 LICENS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—A/HNDLGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U.,�pM E.A. ' <br /> LAVATORY(WASH BASIN) ' <br /> � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS ' <br /> DISH WASHER � <br /> � VENTILATION FAN � <br /> LAUNDRY TRAY ; RANGE HOOD � <br /> CLOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS � GAS FIREPLACE � <br /> SINK(SERV�CE—BAR,ETC.) GAS RANGE � <br /> ' / GAS PIPING <br /> i EKHAUST FAN � <br /> � � <br /> � � <br /> � � <br /> � , <br /> SUB TOTAL $ � SUB TOTAL $ ' <br /> i i <br /> PERMIT S � PERMIT $ — � <br /> TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FPONT SETpRCN REM SETBACK SI�E SETBACN P�AN CIIECK NU R FEE RGf.EIPT NO. <br /> s'�/�3 <br /> use zor+e �ornnen VqCANf SI1E FEES VALUA710N FEE . <br /> I IYES I1 NO OUIL�INC � <br /> i <br /> HEIGIITIIMITRTION NO.OlDWEILING SIZEOFBIOGRI � <br /> 11N17S i <br /> PLIIh�pING <br /> OCQIP�NCV NO p�S10Bi[5 OCCUPANT LOAD BASFMENT MECIInNILp� I <br /> GROUP <br /> i <br /> f1YES il NO <br /> i <br /> FIRE AURM REOD R[p50Y ��DIIIONAL f't�N GNFCN � <br /> O1NER � <br /> FIRF.$PRINKLEO REOD pE�50Y � <br /> i <br /> STATE OIIILOMG SIIRCHMGE <br /> ivrEor'r,or+st PinNsnrrnovenov CITYOFEVERETT runiir,wonKs � <br /> LOCAL SALES • <br /> unre TAX CODE 1S 3105 70TAL ; <br />