Laserfiche WebLink
.., �. n'��1 <br />APPLICATIO��+J FOR CONSTRUCTIJN PERMIT <br />ffre E�rrgrcrn <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 TO BE COMPLETED IN <br />' i DEMOLITION C I COMBINATION !� BUILDING <br />�,v��E�nR �fn,�"'����0� — )(n/`�l ��/�� <br />61A11 A�DRESS <br />CIIY <br />CI7Y <br />21P <br />zm <br />PRINT <br />AN�� / O PLUMBING <br />1/- �U-�' U��� <br />P110NL <br />PHONE <br />`�_� • rR��tT -NpIUAAL CAS INC. <br />259�569� ar�r,r}J� � _ <br />IA[CN�NIC�LGONTRACTOA IA�ILr1DD ���Z'�a� ZIP P110NE LICEN <br />���� McDougnll <br />���4-Wuhln�fen-A��g <br />AlUA1�INGCONIR4C10R M�ILAOORFSS CItY ZIP PHONE UGENSE� <br />GL�SS OF WOfiK <br />I I NEW I. I ADDITION <br />1[NANL IA1Pf10VENENI ON <br />COY7R�C1 PPICEOF WOfll <br />IEGAt <br />LOT <br />NO. <br />oF rnon�nrr �s�iown oaow o� <br />OLOCK OF <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />!:IT(,4EN SINK 8 DISP <br />_I DISHIVASHEfl <br />LAUNLRY TFiAY <br />CLOTHES WASIIER <br />URINAL <br />URINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAINi <br />� f10Nt SE1pACK <br />USL IONE <br />rvrc nr const. nuo�xnui[ <br />s¢e or oioc. <br />OCf.UP�NCYLO�D <br />OH ITEM <br />everett <br />e <br />❑ SIGN <br />! I REPAIR I I OEMOLITION I i WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />roun coriesi <br />SUB TOTAL $ — — <br />PERMIT $ <br />TOTAL FEE $ <br />REAR SE104CK SIDE SElOACH <br />LOT AR[A <br />TYI'E Uf LON51. ACIVAL <br />NO. OF STOf11E5 <br />fIf1E SPRNNlE115 fi[OD <br />I 1 YES I 1 NO <br />nrnsoN FOR SPR�N1cLBR5 <br />nrri.i�ntroNncc.ar rinNswrnoveoer <br />coNincT r�nsor+nr+o v��orve r+o. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APP�ICATION 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 VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR IOCAL V�W REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNAiUREOFCONiR CTOf10RAUT110R12E0AGENI ORTE <br />�� <br />�PPLICAN7SCIiY SINBSSUGFNSENO.AN USMESSNAME <br />N0. TVPE OF EOUIPN <br />A/C—IUHNCLG UNITS—H.P. <br />� FORCEO AIR SYSTEMS-0. <br />� UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />i_ — <br />; VENTILATION FAN <br />� RANGEHOOD <br />! — WATER HEATER <br />� WOOD STOVE <br />� METAL PIREPLACE & CHIMI <br />� FIREPLACE INSER�f <br />GAS PIPING <br />EXHAUSTFAN <br />PL�N CHECN NUMDER <br />VACANT SIiG YttJ <br />I1 YES I I NO pUILDING <br />acurencr xo m mvuurvcu�ms <br />°�� PWM3ING <br />OnSE�.IEr�� MECHAtJICAL <br />I I YES IJ NO <br />IIEIGNTlIM1IATION OTHER <br />STATE �UILDING SURCHAliGE <br />S1ATE ENEfiGV SURCHARGE <br />CITY OF EVERETf ;vOLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TO7AL <br />FEE <br />E.A. <br />SUB TOTA� $ ' — <br />PERMIT $ _ ��'� — <br />TOTALFEE $ ��j�'— <br />FEE RECEIPTNO. <br />VALUATION FEE <br />� <br />_ � <br />i <br />_ �i � <br />i <br />� <br />_ 1 <br />� <br />� <br />— , <br />� <br />� <br />