Laserfiche WebLink
fhe Everpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />APPLIC,aTION FOR CONSTRuCT10N <br />PERMIT <br />evere�t <br />e <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />�i'� �y - �S3 - 6 �/G <br />ARCHITECtOR0E51GN':H MRILADDRE55 CIiY ZIP PHONE <br />J'Ow �� <br />y <br />,a� f�.c�- <br />.s�S�J <br />PLUMBINGLONTRACiOR MRILADDRE55 pTY 21P PMONE �ICENSE• <br />GI.AJ3 VY WUMR / <br />❑ NEW L'�YADDITION ❑ ALTERATION REPAIR C DEMOLITIQN ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING REIOCAfION <br />TENRNT IMPROVEMENT ON INTEPIOR FEMOOEL ON/LY� LONiAQ PERSON ANO PHONE NO ( p /� <br />GONTRRCTPFICEOFWORK / �(l Q�/V ��✓ �iJ��J �J� �LJ �2 <br />,D� SC�Rf E WOPK ANO SOUARE FOOTAGE INVOLVED /J��I.��G <br />,�c+"�irh-✓ -/UX /f� - �� R,,C�e r.�PrEra±F Q�iI �' .P��,� ti <br />PROPOSED USE OF BUIL�ING <br />I HEREBV CERTIFY THAT I HA�E READ AND EXAMINED THIS APPLICA710N ANO <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />IEGRLDESCRIPiIONOFPflOPERTY�SHOWNBELOtY�ORATTACHFOURCOPIE ORDINANCESGOVERNINGTHISTVPEOFWORKWILLBECOMPLETEDWITH <br />�o7�// / WHETHERSPECIFIEDHEREINORNOT.THEGRANTINCaOFAPERMITDOESNOT <br />7L 6LOCK oF � O ��(J� � PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />// � ANYOTHER STATE OR LOCAL LAW REGULATING CONS?RUCTION OR THE PER• <br />�'7"�O — G� 7' G) �C�OO FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE UWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296200 WAC. <br />SIGNAtU F ONTRACTO RAUTHOq¢EDAGENT pRTE <br />I X /����r ���%s� <br />PLUMBING <br />KITCHEN SINKB DISP. <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOi HES WASHER <br />URINAL <br />GlJ / <br />J <br />�7 <br />e <br />FIRESPf;INNLEfl5PEO111pEp ❑ YES <br />i <br />3 <br />ry <br />FEE <br />g� � <br />SIDESET�AG�( � <br />,5 �- I o <br />VRCANI 31TE <br />❑ YES /p NO <br />MECHANICAL <br />NO. <br />OF EOUIPMENT <br />1NITS— H.P. <br />fEMS— B.T.U. M EA <br />B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPI.ACE INSERT <br />HEAT PUMP <br />' NO.OFOWELLINGUNITS ` BUILDING <br />1 PLUNBING <br />BSMT. pC(:. LOFD <br />� � MECHANICAL <br />H[IGNTLIMIiATI N OTHER <br />STATE BUILDING SUIiCHARGE <br />STATEENERGYSURCHARGE <br />� PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />� <br />5 <br />5 <br />PECEIPT <br />FEE <br />FEE <br />r�� <br />