Laserfiche WebLink
&PPLICATII.N ��R CONS7Rl7�"►.ON P�RMIT everett <br />ffiuEvergreon TO BE COM?LFTED IN INK—PLEASE PRINT � <br />GTV OF <br />�ver�tt CHEATING SYSTEM: ❑ GAS [] ELECTRIC Q_ ! <br />BUILC"JG DEPARTMENT — - <br />259-6d10 <br />❑ D�MOLITION I 1 COMBINATION <br />�O:f ER . MFRAD�R�ESS <br />� D/ /z�P <br />TENANT � MAILAOOflE55 <br />,BUILDiNG I 1 MECHANICAL <br />.ITY ZIP PNONE <br />21P PHONE <br />qRC111TEC RD�E8IGNER MAILADOPESS CITY ZIP PHONE <br />I i PLUMBING i I SIGN <br />77G?fLJ� <br />GENEFPLCONTRACTOfi MAILADI1RE55 CITV ZIP PHONE UCE45E1 <br />_I�.J� C,�.��,.l�,.:__ �,�.�2=?.2:�.�s�1�1��1�r.•�.a� S'iio43 71Qsg�aD J�,�sci�c�voF� <br />MECNANICALCONTflACTOR M61LADfiflE55 CIT1' 21P PNONE LICENSE� <br />PWMBINGCONTPACTOF MAILAOORESS CIN ZIP PHONE UCENS[� <br />CLASS OF WORN <br />❑ NEW ❑ ADDITION IjC� ALTERATION I I REPAIR I I DEMqLITION I I WOODSTOVE/FRPL INSERT f�..i BWLDING RELOCATION <br />� ./� CONTACT PEfl50N AND PNONE N'J. <br />GONTflRCTPRICEGFWORK �(�Qa 41a�,�. ..��. �74 'a�'nFO <br />DESGPIBE WORK AND SOVRRE F097AGE INVOLVED <br />/� . 1.. �I 1 -., C� r c� !1 <br />OF <br />LEGAL DESCRIPTIGt! OP PROPEFTV �SNOWN BELOW OR ATTACH FOUP COPIBS� <br />LOT BLOCK _ OF _ _____ <br />WATERCLOSET <br />BATHTUB <br />LAVATORY (WAS <br />SHOWER ^ <br />KITCHEN SINK 8 <br />LAUNDAYTRP <br />CLOTHES WA; <br />URINAL <br />ORINKING FOl <br />FLOOR D�tAl�l <br />BACKFLGW PF <br />ROOF DRAINS <br />I HERC-BY CERTIFY THAT 1 HAVE READ A�D EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUF AND CORRECT, ALL <br />PROVISIONS OF LAWS AND OROINANCES GOVEfiNING THIS NPE OF <br />WOFI( WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />Al'THOfiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE UF LOCAL LAW REGULATING CONSTHUCTION OR THE <br />PERFQRMAh';�_ OF CONSTRUC710N. THAT I AM AUTHORIZED BY THE <br />OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS I.�ADE AND I C9MPLY WITH THE STATE <br />CONTR TORS LAW 27 FCW AYD 290.200 WAC. <br />SIGN RE FCONTRAL ORFUTHOHI2EDFGENT DATE <br />X �.� ian. �7- D) . <br />� '1� I.m(�_�n.,�s (�nu� o�c iim. <br />APPLICFNTS LITY BUSINESS UCENSE NO. FND BUSINESS NAME <br />FEE NO. i TYPE OF E�UIPMENT <br />� NC—NHNDLG UNITS--H.P. <br />; FORCED AIR S`!STEMS—B.T.U. M <br />UNIT HEATFRS—B.T.U. M <br />� CLOTHESDRYERS <br />' VENTILATION FAN <br />� RANGEHOOG <br />; WATER HEATER <br />� WOODSTOVE <br />� 61ETAL FIREPLACE & CHIMNEY <br />i FIREPLACE INSERT <br />—� <br />� HcAT PUMP <br />' GAS PIPING <br />� EXHAUSTFAN <br />FOR OFFICE USE ONLY: <br />FRONTEEIDACK 9EAR3ET9ACK SI�ESETBAGK PLAN <br />USE20NE <br />7YPEOFCONiS.ALLOW BlE <br />v.� <br />SIZEOFBIMl. 5 �F,�•' <br />SS� <br />AREA I VACFNTSITE <br />OCCUPANCT I N00lpKRU5411'llii <br />G,no�v2 <br />// <br />Y.O.OF STORIES <br />� <br />FIRE SPRNKLERS F <br />N � <br />=0°� CITY OF EVERETT <br />LOCAL SALES <br />�� TAX COUE IS 3105 <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />AD�ITIONAL PLAh CHECK <br />GTHER <br />STATE BUILDING SURCHA.iGE <br />PUBUC WURKS <br />TOTAL <br />FEE <br />8 <br />5 <br />S <br />� <br />I <br />I <br />{ <br />