Laserfiche WebLink
f�. _.. <br />��r�iPP1.ICA►TION FO��: <br />. '".E"'°`"° � CONSTRUCTION <br />CITY OF <br />everett PERn�iT <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DeMOLITION �COMBINATiON �,BUILDING T�MECHANICAI_ <br />�1�. <br />7 �! 3�11s� ���.�n <br />. e <br />� PLUMBING ❑ SIGN <br />P_ <br />��. ,�[`�1�—I�rx� l..s.ra c�-Y �ve.�(�.�?_sgA-����hi�r 3�-t-z_� , <br />GENER�LGONTPACI��� MqL n�ORESS Gltt ZIP PMONE LICENSE • <br />M�IL <br />MRI� <br />i OF WOR.N�( <br />NEW p� ADDITIOfJ ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FFPL.INSERT ❑ BUII.DING RELOCATION <br />MFIEHI/1LJ YLUJ LFtlVHI <br />OO <br />�or_ <br />PLUMBING <br />TYPE OF <br />WATER CLOSET �T <br />BATHTUB <br />UVATORV�WASM <br />DISHWASHER <br />UUNORV TPAV <br />CLOTHES WASh <br />URINAI <br />DflINKING FOUI <br />FLOOF7 OFAIN ' <br />BACKFLOW PRE <br />(SERVILE - BAR. <br />: . ,t - F/z <br />S12E OF B100. -t <br />� �� e8� .r�/ <br />� FIRE SPRINKLERS RE <br />i <br />rv,,rr� . <br />SUBTOTAL i <br />PEHMIT f <br />TOTAI FEE S <br />R SETB�CK SIDE SETB�CK <br />�flE�. VAC�NT$ItE . , <br />OYES��NO <br />:t1PANGYGFOUP NO.OFOWELLINOUNITS <br />f.3-2 �- <br />OfSTOPIES M�XOCC LORD � <br />2 onr�o 4�0 �" <br />) ❑ YES �NO <br />�NS CNE� Y APVR. FOR ISSO�NCE BY <br />� <br />� - � . i�- • wT� ��-a��--'l �vly . <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAMETO BETRUEAND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCESGOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR�AW REGULATING CONSTRUCTION <br />OR THE PERFOqM OF NSTRUCTION. �? �( <br />SIGNAT E OF N7 CTOR OR AUTH RIZ[D AGENT DATE II' �J�� I <br />OF EOUIPME <br />ITS - H.P. <br />IITS - H.P. EN. <br />BOILERS - B.T.U./H.P. <br />GAS FIRED A.C. UNITS - B.T. <br />FORCED AIR SYSTEMS - 0.T <br />WALL MEATERS -� B.T.U. <br />UNIT HEATERS - B.T.U. <br />EVAPORATIVE COOLERS <br />VENTILATION FAN <br />FANGEHOOD <br />WATERHEATER . <br />—=� <br />WOODSTOVE <br />METAL FIREPL4CE 8 <br />FIPEPI,ACE INSEPT <br />HEATPUMP <br />GAS PIPIN� <br />EXHAUSTFAN <br />M EA. <br />M <br />M <br />SUBTOTAL ' <br />PERMIT <br />TOTALFEE <br />iCKNUMBER FEE AECEIPTNO. <br />�/� q n a� a, �3o6g I c�� <br />BUILDING S <br />PLUMBING <br />MECHANICAI <br />OLHER <br />STATE BUIL�ING SURCMARGE <br />S7ATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PROPERTY OWNEFS ARE RESPONSIBIE FOR DETERMINING ALL <br />PROPER7Y LINE LOCATIONSAND RELATED EASEMENTS. <br />