Laserfiche WebLink
� � <br />APPLICATIG.1 FOR CON�TRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ,p� COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SI(3N <br />PROJECT ADDRESS <br />�//� �'/��nn �ii % ,..�.� �'. �.JJS CJi?��� <br />DES�GNER <br />MAIL <br />MAIL <br />LVNTRIIGT PqICE OF WORK ' <br />DESCRIBE VIORK AND SW�RE FOOTAGE INVOLVEO <br />Ql'N�4a� (�,, <br />Pi10Pp5ED USE Of BVILpNO <br />LEOAL OESCRIPTION OF W�ppERT/ (5! <br />l0T BLOCK _ <br />PARCELTNII.O.MIMBER <br />CONSiRUC710N LOAN LENOER, AOIXiE <br />/ / <br />r�ur�exw <br />NO. TYPE OF flIC <br />WATER CLOSE? (TOIi <br />BATHTUB <br />LAVATORY(WASH BA <br />SHOWER <br />KITCHEN SINK 8 DISI <br />DISHWASHER <br />UUNDRY TRAY <br />CL0INES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRcVI <br />SINK (SERVICE •- <br />irv zir <br />Gt.i /.l n U'e. <br />/ CITV ZIP <br />S 4do r/-G <br />CITV ZIP <br />CITV ZIP <br />_ OF <br />TELEPHONE NUMBER <br />RE OR ITEM FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SEIBACK REAR SETB�CK <br />USE 20NE 1.0T AREA <br />HEIOMTLIMITATION NO.OFUWELLINO <br />UNIiS <br />ORTE <br />rnvrve <br />STATE UCENSE <br />21P PHONE STATE U�ENSE � <br />PHONE STATEIICENSE� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />GONT/�GJ P6��SOEMND PMOI* NO. . <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 ORDINANCES OOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACT LA 18.27 RCW A 2962 WAC. <br />x p. <br />NA DATE <br />CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF flXTURE OR ITEM FEE <br />A/C —AMNDLG UNITS — H.P. � <br />i_ <br />FORCED AIR SYSTEMS — B.T.U. M E.A. ' <br />HEAT PUMP � <br />UNIT HEATERS — B.T.U. M � <br />CLOTHES DRVERS � <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE I <br />FIREPLACE INSERT <br />OAS fIREPLACE <br />6AS RANGE <br />6AS PIPINQ <br />EXHAUST FAN . <br />SIDE SETB�CN PUN CME 'K NIIMB i <br />.7 <br />VRCANT SITE EES <br />❑YES ❑ NO BUILDIN� <br />SIZE OF BLDORI. <br />PWMBING <br />BASEMENT MECH�NIC�L <br />❑ YES C7 NO <br />�ODIiION�LPUN CNECN <br />OTNER <br />STRTE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />PERMIT $ <br />FEE I RECEIPTNO. <br />