Laserfiche WebLink
� <br />APPLICATION FOR CONST'RUCTION PEFtIVIIT <br />Iho Evergreen <br />CITV OF <br />ederett <br />BUILDING DEPARTMENT TO BE COMPLETED IiJ INK—PLEASE PRINT <br />259-8810 <br />I I DEMOLITION I_] COMBINATION f] BUILDING �MECHQNICAL <br />owNER MRRpDonEss ' ritv Zir :��.:�e <br />��/}c,(�c�v <o,i ST 11; t FI�G�t tq,�o�Ic� (-��=/.:£ii- N� K+-�l �-Sx -9 yso <br />TGN4NT AIAI:�DD(1E55 CI7V ZIP PHONE <br />everett <br />� <br />NG LI SIGN <br />FI1C1111EC70ROiSIGNEB MRILAOORE55 CITV ZIP CHONE <br />c ll � NA�/3A 4� <br />GENER�ICONiRnCtOR IAAILADpRF55 CITY LP PHONE LICENSEI <br />N�i�b�» �Ns T N��-iSn�,� Zgo�>i�r <br />M1IECf1ANIC�LCONTRACTOR M�ILAO�RESS dN ZIP PHONE LIGENSEI <br />0/lv� l}filn<T P���-,!i',K zS7 �9Ec <br />PLUTA31NGG01lLRAC108 MNLADORE55 GIiV 21P PHONE LIf.ENSE1 <br />CL4550F WORrt <br />(7 NEN! I_1 ADDITION ❑ ALTEPATIOh <br />TEN4N1 IMPROVEMENI 0� IN7ERI01/1 R�EfAO�EL .O�IlLY <br />GONiR11GTfNCEOFWOfIK: 'p�y� <br />OESCNOE WORK �N�D SOU"ME f00t�GE INVOLVEO <br />R�c�t�v,... y��ar ti�f"y�c"'-�.0 ) <br />17i REPAIR <br />f',E 15v1c n.- U.95 /� Ur�tr Natx/ �uN� <br />CEGAL UESCRIPiIGN OF PqOPCR7V �SNOWN BELOW OR AT1nGi� fOUR <br />ior�'{�- BLOCK i6S or (�G/�Tof <br />�o J /Y'�Yr <br />JM81NG <br />� TYpE OF FIXTURE <br />WATEfl CLOSET (TOILET) <br />P,ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEH <br />KITCHEN SINK 8 DISP <br />DISHWASHEH <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FIIONi SETDACK <br />FERMIT <br />FERRSElOACN � SIDESETBACK <br />USE20NE I LOTARBA <br />IYPE Oi CONSi ALlO'NF9lf <br />OCCUP4�NC�YlOAO <br />--�— <br />RE�SON FOR SPf11NNLEHS <br />qPPLICATION ACG BY <br />fYC�l'.9H51. RCt�I\L <br />l�_ h� <br />NO.OF STORIES <br />� <br />i'IIIE SPfINHLEf15 f1ECp <br />❑ YES j�i NO <br />FLANS?PPil �EDBY <br />/ <br />1�_1 DEMOLITION I_ I WOODSTOVE/FRPL INSEFI CI BUILDING RELOCATION <br />CONI4CT PEI150N R!D PIIONE NO. <br />FEE <br />VACANT SITE �` <br />LI YES Y\NO <br />acuraxcr Ho�•omu�rcuvns <br />�po-�� V� <br />�i�J VES I7 NO <br />IIEIGIIT IINItAlION <br />EX 1 �T �G <br />CITY Of EVERETT <br />IOCAI SALES <br />TAa COUE IS 3105 <br />I HEREBI' CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TYPE OF <br />WORK WII.L BE COMPLETED WITH WHETHER SPECIFIED HEREII+ OR <br />NOT. THE GNANTING OF A PERMIT DOES NOT FRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ��.NY <br />OTHER STAT[ OR LOCAL LAW REGULATING CONSiRUCTION OR TfiE <br />PF.RFORMANCE OF CONSTRUCTION, THAT I AM AUi NORIZEO BV T4� <br />OIVNER OI° THIS PROPEP.TV TO FERFOqM THE N'URK FOR WHICN <br />/�PPLICATION 1S MADE AND I:iOMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 295200 WAC. <br />SIGNATUBEOFCONIR�CTORORAUiNO(iRED�GENT DATE S—�y��� <br />X � i'' �-�C�, <br />RPPUCANTS CITY �USINE55 LIGENSE NO. ANC OJS�NE55 N�1 �6 <br />METAL <br />fAN <br />PLAN CHECK NJMI <br />90 a 5 <br />FEES <br />DUILDING <br />OF EOUIPMENT <br />UNITS—H.P. <br />fSTEMS—B.T.U. M <br />—B.T.U. M <br />PLUM1IBING <br />NECH�NICr1L <br />OTHER <br />STATE BUILDING SURCHARGE <br />S?A7EENEnGVSURCHARGE <br />PUOLI:WORKS <br />rorn� <br />8 CHIMhEY <br />T <br />1 <br />SUB TOTAL $ � <br />PF.RMIT $ <br />TOTAL FEE $ i <br />FE[ p RE3�o �� <br />�� �. li 0 <br />.�Qi�STJ <br />