Laserfiche WebLink
APPLICATI� N FOR CONSTRaJ�; .ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREE'i •EVERETT, WA 9B^c01 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDING L�7 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROdECT ADDRESS: /3/� Lorn �arCJ AVe �V2✓'e7� <br /> _TacK �-amb . I316 Lo� bard /a✓ F�e�'e� 9�Lo/ .2�7 - 920� <br /> ON?!ER MNL�OORE55 pry z�p P���E <br /> 7EN�NT YNLI�pDRE55 CITY 21P PI�ONE <br /> ARCHITECTORDE514NE0 Mq1AppRE55 Lltt ]�P PIiONF <br /> GENERM Cd/TP�GTOR MdIL AOORESS CIIY IIP P110NE SI�TE UCENSE• <br /> YECHANICAL CONTRACTOH MAII ADORE55 f.ITY ZIP PIIONE STRE LICENSE/ <br /> VLUMBWGCON7R�CiCY1 M�ILAWpE55 LITY ZIP PIIONE STATELICENSE� <br /> CONTRACT PRIGE OF WORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC I� oi � <br /> DESCRIBE WORN AND.SOU�NE FOOTAGE INVOIVED / CONT�Ci PERSON AND PMONE NO <br /> insfa�� 2 S�as a � nce 6a�-6- and ;re �qce <br /> �� � � vs �� es ;,, house <br /> _U e f�, I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPoSEO u5E OF BUIL0INO APPLICATION AND KNOW THE SAME TO BE TpUE AND CORRECT ALl <br /> PqOVIS10NS OF LAWS AND ORDINI:NCES GOVERNING THIS TYPE QF <br /> reS��Qn[e WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OF <br /> LEGAlDESCPIPTIONOFPflOPEPTY�SHOWNBELOWpq�l1�CHTWOCOPIES) NGT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 50F� -z5' -0 2 6 -000y APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMLELTA%I.D.NUMBER CO/N�TRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSipIICTIUN10NIlENDER,�DDpESS.TELEPHONENIIMBER ..Y ����� �� U� �� <br /> 1VlA <br /> �14N�TURE D�i�-� <br /> CITY BUSINE55 LICENSE NO <br /> PLUYBING AIECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM F�EE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—MiNDLG UNITS � <br /> BATHTUB ; FORCEDAIRSYS7EMS � <br /> LAVATORY(WASH BASIN) � I1EAT PUMP �— <br /> SHOWER � UNITHEATERS i <br /> KITCHEN SINK 6 DISP ; CLOTHES�RVERS � <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY ; / WATER HEATtR � <br /> CLOTHES WASHER � WOODSTOVE , <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPWCE INSERT(WOOD BURNING) ; <br /> FLOOR ORAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SEHVICE—BAR,ETC.) � GAS PIPING � <br /> EXHAUST FAN <br /> i ' <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S <br /> _ PERMIT S � PERMIT E � <br /> TOTAL FEE E ' TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRONT SET�ACK REAfi SF.TBALN SIDE SETBACN PI AN CUE(CKCNlIAIgiR / fEF OEf.FIPT NO <br /> J � ���� <br /> USEZONE torene� VACANISITE FEES VALUATION FEE <br /> ❑YE$ ❑ NO —�— <br /> _ OWLNNf. <br /> IIEIGMT UMITATION NO Of DWELLING SIIG OF OIIKRI <br /> i <br /> UNIfS <br /> PLUMOING <br /> GROUPANCY rro nr smm[s OCCUPANi LO�O B�SEMENT MECIIRNIC�I i <br /> ❑YES ❑NO -- '���-- <br /> FIflESPRINKLERREO'U RF�SQY Rp�I110NV PIANCIIfCN � <br /> �_�—_ <br /> 0111811 I <br /> FIREAUBMREO'0 RF�SON <br /> ' <br /> $iqE OIIIl01NG SIIfiC1UpGE <br /> TYPEOFf,ON57 PtANSAPPROVEO�Y CITYOFEVEflETT �IIq11f.\y0(1N$ <br /> LOCALSALES — — —— — -- <br /> o�rt TAX CODE IS 3105 TO7Al. ; <br />