Laserfiche WebLink
APPLICATIO�r�` FOR CONSTRUCTI"'�` N PEI�MIT everett <br />TO BE COMPLETED IN INK PLEASE PRINT <br />(he Fvergrean � <br />CITY OF <br />eve�rett � <br />BUILDIIVG DEPARTMENT <br />259-8810 <br />f 1 DEMOLITION ❑ COMBINATION <br />OWNEq_ M�ILADDRESS <br />�RLHITEGTORDESIGNER MAI�ADDRE55 <br />GENBRALCONTRACIOR IAAILA�DRESS <br />� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I I BUILDING <br />C/!IT`Y <br />� /_ � /� /�"/� <br />CITY <br />CITY <br />� 0 MECHANICAL <br />rZIP PHONE <br />LD <br />21P PNONE <br />❑ PLUMBING b SIGN <br />�5'9_/ 9 St 7 s' <br />CITV ZIP PNONE LICENSE / � <br />p CITV ZIP PNONE LICENSE� <br />' -��o�iS�C qS'Zs � �S'S-So7,�, DAN�LG�RP 1/OXU <br />PLUlA91NGCONTR4GTOR �/ MNLa00BES5 ` `� //��f:ITY ZIP PHONE LICENSE/ <br />7 <br />CLASS OF WORK <br />I I NEW f_1 nDDITiON � ALTERATION f�. I REPAIR I�. I DEMOUTION L I WOODSTOVFJFRPL INSEfiT ❑ BUILDING RELOCATION <br />n�' CONTACT PERSON n/ND� P�II/ON�E NO. <br />CON7AACT PflICE OF WORK /�J O� � O(n// / <br />DE�5 fiIBE WORN AND SOUARE FOpTAGE INVOLVED <br />Knn�G� Y'P�r rnrcf� - ('k•��br� <br />PRO!'O 0 VSE OF At11LOCdG � <br />�or_�_ e�ock � oF � <br />� � �'�' �T <br />PRQIECT ADD�7ES5 <br />3530 l.om� <br />PLUMB�NG <br />NO. TYPE OF FIXI <br />WATER CLOSET (T011 <br />BATHTUB <br />LAVATORY (WASH BA <br />SHOWER <br />KITCHEN SINK & DISF <br />DISH WASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROUF DRAINS--RAIN <br />SINK (SERVICE—BAF <br />OR <br />PERMIT $ I� —� ���1— <br />TOTi1L FEE $ I /i : � <br />FdR OFFICE USE ONLY: <br />FRONi5ET04CK � REAPSETBACK <br />zp =�' <br />usezou�j � �ornaen -3G� <br />K- :� <br />IYPEOiCONIS.ALLOWFBtE iYPEO(G9NSCACIUAL <br />� ' <br />SRE OF BLDG. NO.OF S10RIE5 <br />0 ( <br />OGCUPANCYLUA� FIRESPRNKLERSREO'U <br />/l/� <br />INtAKEOY PVNSAPPflOVEO�Y <br />gL� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPL[TED WITH WHETHER SPECIF�ED HEflEIN OR <br />NOT. THE GRANTING OF A PEFlMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STA7E OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTpACTORS LAW 182' RCW AND 296.200 WAC. � <br />SICNATURE OF CONTRACTOR OR AU7HORIZEO AGENT DATE <br />�/NTS�YBl151PIE55L�SF.N lDBU51 SSNAME ' <br />MECHANICAL <br />�O. TYPE OF E�UIPMENT <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL PIREPLACE 8 CHiMNEY <br />FIREPIACEINSERT <br />EXHAUSTFAN <br />SIOESE7Ff�fN PIANCHECNNUGOER <br />=� _ 27.5.5� <br />VACANi uI lE PEES <br />'�� BUILDING <br />MCUf>ittv NO OIpWFIUNGpHt15 <br />GqppP pWMBING <br />,� �Ckl17�G <br />OnSErnEnr MSCHANICAL <br />u� <br />HEiGHi�AT�oN AODITIONALPLANCHECK <br />/ <br />OTHER <br />STATE BU!LDING SURCl1ARGE <br />CITY OF EVERETT PUBLIC WOFHS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />JUCIVIqL S � <br />PERMIT $ � <br />TOTAL FEE $ �— <br />FEE �' 0 NECEIPT NO / <br />� `� � <br />VAI.UATION FE <br />2i� ' <br />� <br />1 <br />i <br />i <br />i <br />, <br />, <br />� , <br />i <br />i <br />� <br />i <br />