Laserfiche WebLink
APPLICATION`�r'OR CONSTRUCTIO.� PERMIT �Vefe�t <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Evergreen - <br />CITV OF <br />eve rett HEATING SYSTEM: �J GAS C] ELECTAIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLITION I] COMBINATION I I BUILDING I I MECHANICAL �rl'{'LUMBING l:l SIGN <br />OWNER MAILADDRESS CIIY 21P PHONE <br />�'Ur2�i7-iS�.i,�si�t -f- I�v! Pv9K(,��c d=�7i� �Zo <br />icu�ur M�IL OPESS CITV ZIP PHONE <br />nf1GHI7EG7 OR <br />AODIlE55 <br />CIIY :�P PHONE <br />GIIY tn• ..�..�•.. <br />MEGNANICPLCONTflACi0i1 MMLADDRE55 ""' <br />PLUMOINGCON7(i�CiOfi lAAILAOOfI[55 CILY ZIP PIIONF LICENSE� <br />TD�` s��LUnz�i�v� t�� �,r i/j � _«P, r,r �s� ���� /�� ��-r �ro�-, r L3s �� z_ <br />CUSSOFWORK � <br />I I NEW I I ADDITION I�TERATION I I REPAIR I I DFMOLITION I I WOODSTOVE/FRPLINSERT (.1 BUILDINGRELOCATION <br />CON7ACT PERSON AND PIIONE NO. <br />WOfiK <br />PROPOSEO <br />IEGAL <br />ior <br />IO SOUARE POOiAGE INVOIVED <br />�IDINCI � <br />T �- <br />V OF PROPER7Y (S��aWN OELOW OR A71AC11 FOUR <br />BLOCK _ OF <br />PRQIEGTRDORESS <br />/l z 3 1�o P� <br />PLUMBING <br />un rvaF nF FIYTURE OR ITEM <br />SHOWER <br />LAUNDRYTRAY <br />CLOTHES WASF <br />ROOF <br />FOR OFFICE USE ONLY: <br />��..��ecrosr¢ f1EAR5ETBACK <br />USE 20NE <br />ime or cox�s. � <br />SIZE OF �LDG. <br />OCGUPANCYL <br />raensoN Fon: <br />IHIANE BY <br />TOTAL <br />LOT �REA <br />IYPC 0( CONSI. ACIIIpL <br />NO. <br />ov <br />Ei <br />SIDE SE10�CK <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br />ApPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTOPS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUREO ONiRACiOROflAUTHORIZ_D�GENT DATE <br />X ��_ ��� �7�//�% <br />�:y <br />APPIIC ISCITVOUSINESSUCENSENO.ANDBUSINESSNAME <br />N0. TVPE OF EOUIPMENi � <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M _ <br />CLOTfiES �RYERS <br />VENTILATION FAN <br />FiANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPUICE INSERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUB TOTAL $ <br />— PEarnir a <br />TOTAL FEE S <br />PLANCNECNNUNOEiI fEE �IECEIPiNO. <br />UUILDING <br />aarexcr xoamv�umcuwis <br />�P0°r PLUMBING <br />OASEMENT MECHANICAL <br />NEIG/ITLIIAIT�TION ADDITIONALPIANCH[CK <br />OTI{GR <br />STA7E BUILDING SUf1C1i�RGE <br />CITY OF EVERETT PUOIIC WOfiKS <br />LOCNLSALES <br />TAX CODE IS 3105 TOTAL <br />