Laserfiche WebLink
�, - <br />APPLICATION FOR CONSTRUCTIa�N PERMIT <br />CIN OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING p MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �� �� ioc���t>+-�tir� A v� <br />-�oE I�E,•��•/C� 37U1 /_oc,C�Fvcc�,c �,�t�� "Z <br />OWNER MnIL�DDPE55 C17V ZIP pMON[ <br />T[NANT <br />CITY jIP <br />�RCHrtCGT OR DESIGNEn M�II ��bFE55 �Itt )ip P110NF <br />GF.NEnnl <br />vT� <br />MM�ApDRE55 gpy <br />M�II �DDPE55 Cltt <br />�a:2v�u"� t3tTtIZS�3 .�il.c, Ci�c2"-K- <br />IiP PMO4G GIRTC VCCNSE � <br />IIP pNON[ $TRTF UCENSE � <br />���i2 yL5'7�5-SS� P�SD� L- <br />Z�P PNONE STAiELILENSE� <br />CONiR11Ci PRICE OF WORN <br />jIG� � MEATING SYSTEM: GAS ❑ ELECTRIC ❑_ <br />DESCRIBE WOFK AND SOU�RE FOOTAGE INVOLVED CONT�CT VENSON �ND PNONE NO �/ f` <br />1,-�S��r+-•— G�TS 1 �J5��7 t�'�5 %/LCE iTi9.lbrJb ,�C� % y.r7' 'u�79� <br />S�DUC— c�.e�j% 56L.f I <br />/"� u n i <br />LFG \L OESL <br />tor _ <br />BLOCK <br />/1 M. . <br />COPIES� <br />CONSTRUCTION LOAN IENDER. ��HE55. TELEMIONE NUMBER <br />� � PLUMBING <br />1 NO. TYPE OF FI7(TURE OR ITEM FEE <br />� WATER CLOSET (TOILET) <br />�� BATHTUB � <br />LAVATORY (WASH BASIN) , <br />SHOWER � <br />KITCHEN SINK 8 DISP � ; <br />DISHWASHER i <br />LAUNDRY TRAV ; <br />CLOTHES WASHER —� <br />URINAL � <br />DRINKING FOUNTAIN ; <br />FLOOR DRAtN � <br />BACKFLOW PREVENTERS ; <br />SINK (SERVICE — BAfi, ETC.) <br />— - i <br />SUB TOTAL E ; <br />PERMIT $ , <br />TOTAL FEE S ! <br />FOR OFFICE USE ONLY: <br />fRONTSFTpACN Rf:RR SF.TBACK <br />USEZONF �IOI�FE� <br />IIEIGIII f �MIIAT10N � NO OF pWEIIING <br />IINtl V <br />OCCIIP�NCY N' @ SII1niFS Of,CIIDAM LURp <br />cuour <br />� naEsrniNra.EHnEo�o <br />UATE <br />SiOE SE tB�CK <br />V�C�M $li[ <br />❑YES ❑ NO <br />SIZE O� BIOG�f I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TfiE SAME TO BE TRUE AND COFFECT qLL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GR4NTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUI.ATING 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 />CO�TRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br />x �d 1 �^i�i.^ t,� I(-(i, _ �7 <br />SIGN�TURE � D�TE <br />CITY BUSINE55 UGENSC NO <br />NO. I TYPEOFEQUIPMENT I fEE <br />wv — rvnnuw �m i o <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHeS DRVERS <br />RANGEH00� <br />METAL FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />SUB TOTAL E r/ ' <br />PSRMIT $ / s � <br />TOTAL FEE S � . . <br />PtFN GIIECN NU�!NFIi � fEF � �PCFi�i NO <br />IfilI1�W(: <br />Pll!MBWG <br />_ _"—"____7__ <br />PM[NI MFG��Mf.PI <br />❑VES ❑ NO '-- -- - �-- <br />— nooinor+ni.nnNa¢c� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />on�en <br />sr�i[ nmiowc sunc�mnr.e <br />PIIfl11f. WORN$ <br />TOTAL <br />-- � --- <br />--'--- <br />