Laserfiche WebLink
-�. i-. <br /> APPLICATIO.� FOR CONSTRUCT►.1N PERMIT <br /> CITY OF EVEREI7•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOIITION Cl COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> ! `709 �a�s a��. E���a�zr qszAi <br /> OWNER MAIL�DDRE55 CIN 21P PHONE <br /> ?N�'17R5 !.J C', �r '-f9Zl Fa7�fs �0, ��EILEzr' R8Zv5 335-a7�b <br /> 7ENANT MAILADDRESS CITV 21P PMONE <br /> �RCMTECTORDESIGHER MAILAOORE55 GIiY IIP PMONE <br /> GENEMLCONTRACTOR MAILAOORE55 CITV ZIP PHONE STATEIICENSE� <br /> MECHANICALCONTRACTOR MAILADDRE55 CITY ZIP PHONE SiATEUCENSE• <br /> PLUMBINO CONTRACTOR MAILADDRE55 CITV 21P PHONE STRTE LICENSE� <br /> CONTMCT PRICE OF Y/ORK <br /> HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ • <br /> OESCRIBE WORN AND SOUARE FOOTMiE INVOLVEO CONTnCT PERSON AND PHONE NO <br /> � ' a S F an/A � � 3-(dY <br /> 2�l c <br /> I HEREBY CEiiTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPoSED USE OF BUILUINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br /> /D RL WORK WILL BE COMPLIED WITH Y�HETHER SPECIFIED HEREIN OR <br /> LEOAL�DESLCPo�P�TIONOFPROPERttISHOWNBELOWORATfACHTWOCOPIES) NOT. THE ORANTINO OF A PERMIT DOES NOT FRESUME TO GIVE <br /> �oT�.LS�BiocK�or� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> _ 1 ' \ OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> �JC�CI.� N f V„ SraEE{�YY)iSH ��TY WR PERFORMANCE OF CONSTHUCTION.THAT I AM AUh10RIZED BY THE <br /> "� � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P EL TiV(I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Z - - - O I/n'^ ^� <br /> CONSTPUCTION LONI LENDEq,AODRESS.TELEPHONE NUMBER x�� l l � IQ L� �� <br /> SIGNATUR^E ��� pTE <br /> lJL <br /> CIT/BUSINESS UCENSE N0. <br /> , p���N({ MECXANICAL <br /> NO. TYPE OF fl%TUNE OR ITEM FEE NO. TYPE OF fl%TURE OR ITEM FEE <br /> WATER CLOSET(TOILE� � AIC—AMNDLO UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEti7S—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> $HpW/Ep � UNIT. HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS _T_ <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TRAV ; RANGE HOOD _ _�_ <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINO FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> —r— <br /> FIOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKROW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � OAS RAN6E ' <br /> � OAS PIPING � <br /> ; EXHAUST FAN � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL $ � SUB TOTAL $ i <br /> PERMIT $ i PERMIT 5 � <br /> TOTALFEE $ � TOTALFEE S ' <br /> FOR OFFlCE USE ONLY: <br /> FRONT SE7BACK REAR SEiBACK SIDE SETBACK PLAN CHECK NUMBER FEE NECEIPT NO. <br /> use zcNE LOT�REA V�CANT SITE FEES VALUATION FEE <br /> � <br /> ❑ves ❑ no BUILOING ; <br /> IIFIGMTUMITATION NO.OFDWELLING 97EOFBLDGR.L � <br /> i <br /> UNIT$ P�UAIBINC � <br /> OCCJP�NCV NUAf5T0ipE5 OCCUPANTLOAD BASEMENT MECNANICAL , <br /> GROUP <br /> ❑YES fl NO j <br /> FIRE AURM REO'D AEAS(W ADDITIONAL PUN CNECK � <br /> � <br /> OTHER i <br /> FIRE SPRINICLEP REO'D REASON i <br /> STATE BUILDING SURGNARGE i <br /> 1YPEOFCONSi. PUNSAPPPOVEOBY CITYOFEVERETT PUBLICWORNS � <br /> LOCALSALES : <br /> o�re TAX CODE IS 3105 TOTAL <br />