Laserfiche WebLink
� � <br />APPLICATIOr� FOR CONSTRUCTION PERMIT <br />CI-fY OF EVERETT • BUILDING DIVISIUN <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL �PLUMBING ❑ SIGN <br />PROJECTADDRESS: �C� S �2��c.e��t. Gt/aY —!�. I�atinc�� �{ SS `)'$'� <br />OWNER MML�DDRE55 Cltt ZIP FHONE <br />TENANT <br />u -C!�'� <br />M�IL ��DRE55 <br />LITY r /Z�IP�f P110NE / C,/ / <br />fI f� S/- lG > CI �� � ��, � (J�i? / <br />J <br />l�__ � <br />CIIY <br />!u� rnvnc <br />MF.CHANICnLCONTRACTOR MAILADOHES$ Cltt ZIP PI/ONE ST�TF.IICENSE� <br />�P MBINGCONTR�CTOR MAILADDPE55 CITY ZIP PHONE STATF.IICENSE� <br />/il/E55�1/(C� 3 !l �G��'I.G�I !�^�� 5'�Zd Z.S 8'0 ��ESSAi6s �(3 <br />COHiRACi PRICE OF WpRK <br />'�' -y p-'� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DESCRIBE WORK ANO SOU�RE FppTAGE ����OLVEO CONiACi PFPSON ANO PHONE NO <br />PROPOSED USE Gi PUILDING <br />LEGRL DESCRIPTION OP PROPERTY ISHOWN BELOW OR ATfRCH <br />LOT BLOCN _ OF <br />PARCELTA%I.D.NIIMBER <br />CONSTRUCTIONLOANLENUER.ADOFESS.TELEPHONENUMBER <br />PLUMBING <br />NO. TYPE OF fl%TURE OR ITEM <br />WATER CIOSET (TOILET) <br />BATHTUB <br />/ LAVATOAY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUBTO' <br />PERMIT <br />TOTALF <br />FOR OFFICE USE ONLY: <br />FRONTSFTAACN RF.AR SFiBAGK <br />USE20NF <br />NEIGMT IIMItAT10N <br />OGGl11`ANCY NO 0� S <br />GROUP <br />FIRE SPPINKLER REO'D <br />IOIAFEA <br />NO.OFDWELUNG <br />UNiI$ <br />$ <br />VRCANf $I7E <br />❑YES ❑ NO <br />SIZE O� BLOGrtI <br />❑YES ❑ NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORFECT ALL <br />PROVISIONS OF LAWS AND CRDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLIED VIITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A F'ERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE CR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAVJ REGUTATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAVJ 1827 RCW AND 296.200 WAC. <br />���-c-�-,-.�-� - 2S - 2 � - i % <br />SIGNIC� D�TE <br />GTV BUSINE55 LICENSE NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT <br />No — wnnuw unn a <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />HEATER <br />GAS <br />00 <br />PUNCIIECRN/OMPEN /J �EF <br />jC� Q <br />FEES <br />9UIl�INf, <br />PLUM9ING <br />MEf,M�NICRI <br />ApDI110NA1. �l A': CII[GK <br />OiNE�i <br />$TniE OIIIIDING SUf1C11nRGE <br />°Y CITY OF EVERETT nunur. wonKs <br />LOCALSALES <br />TAX CODE IS 3105 70TA� <br />SUB TOTAL S <br />PERMIT 3 <br />TOTAL FEE S <br />ner.eir* No <br />FEE <br />