Laserfiche WebLink
.: � - . . .. . .... . . . l I <br /> � , � I <br /> APPLICA110N FOR CONSTRU�TION � <br /> PERMIT ' <br /> ths Everpreen <br /> CITY OF � everett - <br /> ev�rett e <br /> BUILDiNG DEPARTM[NT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWNEq MMLAODRE55 GITY ZIP PMONE <br /> L-u(�,� �,� �=1.� ,� Po, J�,� /�� y l��a,�(� 4,FzoC X.x-� -z� 4 / <br /> IEN�NT M LADDFESS CITY Z P110 <br /> �qCHITECTORDESIGNEH M�IL�ODRE55 GITY ZIP PMONE <br /> GENEMLCONTR�CTOfl MAIL�ODPESS GITY 21P PHONE IICENSE• <br /> MECHANIC�LCONTR�CTOR M�ALAUORE55 CITY 21P PMONE LICENSE• ' � <br /> I <br /> VLIIMBINOCONTR�CTON MAIL��DRE55 GTY ZIP PMONE LICENSE• � <br /> CU55 OF WORN 1 <br /> 1 <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WCODSTOVE/FFPL INSERT ❑ BUILDINO RELOCATION � <br /> TEN�NTIMPROVEMENTORINTEq�ppPC�ELOf�IY WNTACTPEPSON�NOPIIONENOIIA iL d✓ �l ��I1� I � <br /> �.1� tY <br /> CONTPAGT PpICE OF Vq1i1C 1 �� I <br /> OESCNIBEWJRNAN�Sf}LMEFOOTAUEINVO D I <br /> eouatoFeuaon+ , 2 / iHEREBVCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPLICATIONAND �� <br /> _���� v KNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWSAND .I <br /> �e \LDEBGR I OF P �PERtt�SNOWN BEL oa� ACH FOURCOPIES� ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br /> WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OFA PERMIT DOES NOT <br /> �or..Ir� BLOGK__ OF M ��T Inl P,I � PRESUME TO GIVE AUTHORINTO VIOLATE OR CANCEL THE PROVISION9 OF <br /> ANY OTHEP�TATE OR LOCAL LAW REGULATIND CONSTRUCTION OR THE PER• <br /> �J FOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE OWNER OF <br /> �aYG J/ /�- Cn �t I��Q{ THIS PROPEPTV TO PERFORM THE WORK FOR WHICM APPUCATION 13 MADE <br /> AND I COMPLV WITH THE STATE CONTRACTOR$ LAW 1827 RCW AND <br /> 296200 WAQ G/�� . <br /> $i6N�TUNE O'CY��N O LiMO RE���FNj G rX I C!Z^I�!/ <br /> L LL <br /> X <br /> . <br /> MOJELTADORESS . <br /> APPLI �NTSCITYBlISWE LICENS .�NDBUSINESSN� E <br /> 3�d / L-�� � � <br /> PLUMCINO M CH�HICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE � <br /> � WATERCL03ET�TOILEn A/C-A/HNDIGUNITS-H.P. <br /> BATHTUB FORCEDAIRSYSiEMS-B.T.U. MEA �, <br /> UVATORY�VJASHBASIN� UNITHEATERS-B.T.U. M - <br /> � 9HOWER CLOTHESDRYERS � <br /> �. KITCHEN SINK 8 DISP. VENTILATION FAN , <br /> . DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER � <br /> � CLOTHESWASHER WOODSTOVE <br /> URINAL METAL FIREPLACE 8 GHIMNEY <br /> ORINKINO FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP j <br /> BACKFLOW PREVENTERS GAS PIPING <br /> HOOF ORAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> I <br /> - I <br /> SUBTOTAL S SU8701AL 5 I <br /> PERMIT S PERMIT S � <br /> TOTAL FEE S TOTAL FEE E ' <br /> FRONTSETBACK REARSETMCN SIOESETBACK PLANGHECKNUMBER FEE RECEIFTNO. <br /> use2oNE �oi�aE� WC�NTSITE FEES VALUAT�ON FEE � <br /> ❑YES n No � <br /> TVPEOFCONST. OGGUP�NCYOROl1P NOAFOWELLINOUNITS BUILDIN(3 _ ' <br /> ♦LLOWABLE/ACTU�L PLUMBING _ �III <br /> SIZEGFBLW. NOA�STORIES BSMT. OGGIOAD ��, <br /> ❑Y MECH!NICAL <br /> ❑N <br /> NEIGNTLIMIT�TION OTHER <br /> _ q <br /> FIRESPRINKLERSREOUIPED OYES ❑ NO STATEBUILDINGSURCHARGE �I <br /> II <br /> STAIE ENERGV SURCHAFGE <br /> �PPUGTION AGG BV P`l��li_�PPR.BY <br /> �Vu�/ PUBLIC WORKS <br /> \y'�'� � Cj�i � TOTAL <br />