Laserfiche WebLink
. . , . � � .f1C� �c� <br />� APpLICATION 'r-OR CONSTRUCT101.' PERMIT everett <br />fhe Evergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett HEATI�lGSYSTEM: ❑GAS e�ELECTRIC ❑ <br />B'JILDING DEPARI'MENT <br />259-8810 <br />DEMOLITION ; COMBINATION iG BUILDING : MECHf1NICAL _i PLUMBING I SIGN <br />MAIL <br />TE� ANT MAIL A�OFc55 ,�/�� Q,i� �T J,� �� Z� 9 d� 90 PMONE ♦/��_�� J r <br />�h, G'ocE7h/r,J /.r/3c - f �`_.`� � <br />ApLMITECiORJESIG R MAILADDRE55 CIN Z PHONE <br />S`r�t'R�.� ���� C�S�y ��Sw�c� �nwN. q$z4o 3.3�! �2,�47 <br />� GENERAL CONTPALTOR MAIL ��DRE55 •,�r^�TY � ^ ZIP M" ^ PHONE, _ LIC N �y.� <br />z �e J �� W <br />MECHANICnLCONTPACTOR MAILADDRESS CRY ZIP PHONE LICENSEM <br />%LC COLE"7�9.✓ GU.tT �L.UG %T/•i� _ ///+-� GL... J'E' �' < %fLSOYF/-TlfT iCC�LG.LIJ-1.!/� <br />PIUMBING CONTRACTOR MAIL AOORE55 GTY ZIP PMONE LICENSE k <br />�C S OF WORK <br />NEW C; ADDITION .-_i ALTERATION �, ! REPAIR L' DEMOLITION -. .��. WOODSTOVE/FRPL INSERT .. 1 BUILDING RELOCATION <br />CONTRACT PRICE OF WORH ���J <br />�SCRIa€ WOFKANOSOU�NEFOOTA EINVOIVED .� � <br />`� ��'� �u,i'l�j�` Z02j <br />Pqc;'OSED USE OF BUILDING <br />R.� �J'�R �- <br />LEGAL �DESCRIYioJN OF PFOPERTY (SHON'N BELOW OR ATTACN FOUR COPIEg$) <br />LpT !/ B�OCK OF �Sp S �� �/ <br />PLUMBING <br />O. TYPF OF <br />WATER CLOSET <br />BATFITUB <br />J LAVATORYIWASI <br />8 <br />OR <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />FOR OFFICE USE ONLY: <br />FROYT SETj][CN / REAR SET� / <br />Li�/ <br />USE ZON - `� LO�i A)REA <br />/ � �� <br />7VPEOFC04i5.ALLOWABtE iYCEOFWtlST.ACtU <br />v- <br />2$`23pF gL� � NO.OF Sj,OfilES <br />�D S ) <br />o�. <br />OCCU�PA/N.^.Vy� AD FIRE SP�.RNlHLERS R <br />/ V / I'T Y�l% <br />INTFKE DY <br />PIANS APPROVED BY <br />L�'� <br />SIDE SETB,CH <br />co ovon�ewxsuw*s <br />2 <br />n c� <br />CITY OF EVERETT <br />LCCAL SALES <br />TAX CODE IS 3105 <br />NO. <br />202 <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 ORDIIJANCES GOVERNING THIS TYPE OF <br />WORK WI! L BE COMPLETED WITH WHETHER SPECIFIED HEREIN 09 <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK f-OR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.20� N,'AC. <br />SIGtlAiUflEOFCONTRACTORORAUTHOPIZEOAGENT DAT[ <br />NAME <br />TYPE OF Ef1UIPME��T <br />JDLG UIJITS—H.P. <br />41R SYSTEM�.i—B.T.U. M E.A. <br />iE'RS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATE� HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIflEPiACE INSERT <br />HEAT PUMP <br />�/ �( �yC6 <br />n.�i1 r— <br />IECK NUMBER <br />����� <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />PUBLIC WORKS <br />TOTAL <br />rtt <br />TOTAL FEE $ � / <br />FEE RECEIPTNO. <br />� � T� <br />VALUATION FEI <br />53 i`G� %n <br />