Laserfiche WebLink
�' 1 <br />APPLICATIOrI FOR CONSTRUCTtON PERIIAIT�w%,ls <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 ��T <br />f7 DFA�OLITION i I COMBINATION n BUILDING n MECHANICAL r� pLUMBING n SIGN <br />PROJECT.4DDRESS <br />1430 ��-�zoNi�-- <br />OWNER MAILR�DRESS Cltt ZIP f'HONE � <br />�,�-��,A-�.�� �rST��;a2s,�� ?�'7z3 (N�Trv�v �E �✓� �#/'r� G�✓�/L�'�G✓H'.�)8ao� _ <br />TENANT MPILADOPESS CItV ZIP PHONE <br />5,�-►�, E (f5 n�✓�✓�..rr.. <br />ARCHIIECT OR DESIGNER Mall ROORE55 CITY ZIP PNONF <br />S�t' To (3��/� <br />GENEiIAICONiRACTOF MAILA�ORE55 GTV 21P P�IONE SIATELIL[NSE• <br />MELHANICqLCONTPACTOR MAILADORE55 Cltt ZIP PIIONE STRELICF.NSE� <br />PLUMBINGCONTRaCTOR MAllA0CRE55 QiV 21P PNONE STAiELICENSE• <br />'_......_.... _ <br />� Jr/ <br />DESCRIBE WORN AND 5011ARE FOOTRGE INVOLVED <br />� i..E:/S L (LES /pC�NGE <br />;-w'� 5� i�/� ��%�P <br />C�NC. <br />(SHOWN BEIOW OR <br />LOT� V BLOCK <br />PARCELTq%I.D. NIIMBER <br />CONSTRl/CT10N LORN LENDER. ADDRE55, TELEPHONE NUMBER <br />OF flXTURE OR <br />SHOWER / <br />KITCHEN SINK & DI�� <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />FOUNTAIN <br />PREVENTERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALPEE $ <br />FOR OFFICE USE ONLY: <br />FPONT SETPACN l REAfi SF.iB4C � <br />� �_ <br />USEZONE � / IOTAFEA <br />..i <br />HEIGIITL:MITwION� / NO.OFpWELLING <br />UNIiS <br />NO <br />G <br />— /J <br />HEATING SYSTEM: � GAS fl ELECTRIC I l <br />CONTACTFERSONANOPHOYENO. <br />�NA-�.) �`sres-t,�/�o.�',..s,�� z�F sr"�3 <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 ANO ORDINANCES GOVERNIN(i THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRnNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAI' I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X � �--�1 l � ���--�� � lE /�s� <br />SIGNATIIRE DnTE <br />QTV BUSINE55 UCENSE N0. <br />FEE NO. iVPEOF�E�UIPMENT FEE <br />:ixu <br />AIRSYSTEMS—B.T.U. M E.A. <br />'ERS — B.T.U. <br />DRYERS <br />ON FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WO00 BURNING) .3(7 <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN / _ <br />SIDESETBACK �L�NCUECKJylMHER / <br />s- 'i�xr% <br />VACAN7 SIiF FEES <br />(IYES fi NO ppIL01NG <br />,F BLIX3R . ��VI�V4 f <br />�y s PlUM01NG <br />�.S ..� �J�.��i�`..� <br />BASEME�NT MECIUNICAL <br />KYES Ih NO <br />AODIIION�I. PL�N O�f:CK <br />011l[R <br />STN[ BIOI�ING SURCHARGE <br />CITYOFEVERETT runiir,wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />%5/, �3 <br />FEG BECEIPiNO <br />��,o, yo <br />�� <br />/Z 9�'. L'.�� <br />