Laserfiche WebLink
M� Ere�9reen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />:�� '� ,��, '��''�. <br />APPLICti:�ION FOR CONSTRt,�T10N <br />PERMIT � <br />TO BE CORAPLETED IN INK— PLEASE PRINT <br />M�R�ODPE55 GiY ZIP f'110NE <br />ONNER . r _ � / . _ •� i _.1� �..n.. �� 9 �liw b�Il <br />ANCNrtEQG9DE5�GNER MAIL�O�HE55 CI1V ZiP PNOHE <br />TpAGtOR <br />M�IL�OORE55 CITY LP �NONE LIGENSE• <br />MECH�NIGICANiR�CTG9 M�RAOORC55 GITY ZIP PIIONE LICENSE• <br />PIUM&NOCONiP�CiOR MML�DOAFSS Ci1V )�� PIIONE LILENS[• <br />❑ NEW ❑ ACDITION ❑ A�TERAiiON <br />TENANTIMPpOVEMEM��0111N1ER10RREMOUE} N �_ <br />WNTRACT PRICE OF \VORK <br />�n" <br />pE9ppIBEN'OqK�NG50U�HEf T�6EINYOlVEO <br />� � <br />FROP09 0 VSE OF e NO • <br />IEN� �PTI NOFPPUPE T'�SH(T'�NB LOWOR <br />�o�.jxaKz�� oF � <br />/�/��F 131� 73- <br />„Z.z ��_�� /a-7 � 3 <br />,�ECI�DDRE55 <br />/ iL0 �/�!'/dl <br />' ' pWMBINO <br />Np, TYPE OF FI%TURE OR IT <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY(WASH BASINI <br />SNOWER <br />KITCHEN 81NK d DIS�. _ <br />REPAIR ❑ DEMOL1710N C� WOUIISTOVE/FflPL INSEF�i ❑ BUILDING RELOCATION <br />�� <br />91NK (SEHVIOC — tl�n. e n..� <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />ET&�CIt REANSETBI�CK <br />� �fg' <br />E LOTAREA l� <br />/O� / �i'' <br />fANST. OGCUP�NC� Gf10UP <br />3lFALTU�I /`�C�/' / . �f <br />�p� NO.OFStoHiES BS <br />w Y <br />K % o r+ <br />LEPS PEOU�AED O VES �I NO <br />�� <br />�eccer PUN9�GPRBY <br />�-�L <br />S <br />a <br />E <br />O YES <br />NT <br />1 HEREBY CERTIFY THAi I HAVE READ AND EXAMINED TIIIS APPIICATION AND <br />KNOW iHE SAME TO BE iRUE AND CORREGT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING TNIS NPE OF WORK WILL BE COMPIETED WITH <br />P E UMETOGIVEAUTHORI7YTOV�IOIA EORCAINCEITHEPR0iV191�ON50F <br />ANY OTFIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER• <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUif10RIZED BY THE OWNER OF <br />ANIDPRCOMPVTWITHRTHEM5T4TFWCONTRACTJORSHLAW`1B2T7�RCW AND <br />z962� WA�. ir �a -Bb <br />SIONAfU�EOFLONiH�CiONONAUi110N2E��GENt OAIE <br />, <br />X ��..�� ���--� <br />�ppLiGANTS GITY eoaintsa u�cwc nv. ��� BUSME55 N�ME <br />MECHANICIIL <br />NO. T`IPE OF,E�UIPN <br />A/C— NHN�LG UNITS— H.P. <br />FORCED AIR SYSTEMS— BT i <br />UNIT HEATERS— B.T.U. M <br />CLOTNES DRYERS <br />VENTILATION FAN <br />RAN6EHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNE <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING _ <br />SUBTOTAL S <br />PERMIT S <br />mre� FEE S <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUIIDING SURCHARGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />I�3S <br />