Laserfiche WebLink
APPLIC�,TIG� FOR CONSTRUC'�Jl�f PERMIT <br />CITY OF EVERETT • BUfLDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 `��'� <br />❑ DEMOLITION ❑ COMBIMATION ❑ BUILDING ❑ MECHANICAL ,�9, PLUMBING ❑ SIGN <br />PROJECT ADDRESS: `��as � � <br />l_ e,,,u., n�-l; /l, s �>2D — S�C C Ue��.�� dKa(l (,�a... _ 35�7-So/3 <br />GENEIUL CONTRACTOR M�IL /�DDRE55 CITY IIP P110NE SGTE UCENSE � <br />MEGNIINICALCONIHACTOR M/�IL�DORE55 <br />PLUA6MMCONTR MMLAOORE55 <br />JS.Z��J,�Ac��� YUlec� - ► <br />GONTiUGT PPoCE OF WORK <br />OESCRIBE V/ORK �NO $OUARE FOOT�GE MVOWEO <br />rnoeoseo use a ein�drxi <br />lEck oEscwrna+ a rrrovean (s�avm eE�ow or+�rr�cN nvo <br />l0T BLOLI( OF <br />PIHCEL TA% I.D. NUTA9ER <br />CONSTMICTION lOM! LENDER. AOOf1E55. TELEPIIONE MIMBEH <br />PLU1181Nii <br />NO. TYPE OF FlXTURE O!i ITEM '� <br />WATER CLOSET (TOILEn I <br />BATHTUB ' <br />� UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETCJ <br />SUB TOTAL S <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRRIT SETBACK REAq SE7BACN <br />USE ZONE <br />HEIGNT UMITATION <br />IOT�REA <br />NO OFDWELUNG <br />UM1�TS <br />SfMES OCCUPANT IOAD <br />BY <br />SIDE SETBI�CI( <br />Qtt <br />.,:f� <br />FEE <br />PHONE STATE LICENSE • <br />ZIP PIIONE ST�TE LIGENSE <br />A,�� 5� MrIIC�<.�Ic.-�vZu6uy • A�urf�,E <br />HEATING SVSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />COMACT VERSON ANO PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 ORANTING 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 BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 AND afi200 WAC. <br />x <br />/ i3 <br />5 �TURE D�TE <br />GTV BUSINE55 LICENSE NO. <br />N�. TYPE C�f EGUIPMENT � FEE <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYERS <br />METAL FIREPLACE <br />GAS PIPING <br />VACANT SITE r«� <br />❑YES ❑ NO Bl11lU1Nf. <br />SIZE OF BIOGR I <br />PLUMB:NG <br />B�SEMENT MECH�NICPL <br />❑YES ❑ NO <br />ppUITION�L PLAN CMF.GN <br />OTMER <br />STAIE flllllDMf SIIRLHARGE <br />CITYOFEVEREIT rusiir.woaKs <br />LOCAL SALES <br />TAX CQDE IS 3105 TOTAL <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE S <br />FEF � RECEIPT NO <br />