Laserfiche WebLink
,..._ <br />APPLIC�..'ION FOR CANSTRI►�:TIOW <br />PERMIT <br />. . � <br />Ihe Evarqreen �v` '�t <br />CITY OF � <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br />OWN[R AIAILADORE55 GIIY ZIP PIIONL. <br />. i� _ � ., �-, o �-_ . � \., F..�oc.rr WFL �S2.o3 3``i3'-7y7L <br />ARCHITECiORDE5IGNER MAILADDRE55 'TV 21P PHONE <br />G[NEPALCOHTR�CTOR MAILR�DIiE55 CIiY ZIP PMONE LILENSE� <br />MEL AMICALCONTR�CiOR M11LAO�RE55 LtTY ZIP PMONE LiGENSE• <br />CLUMBINGCONTRPGLO(i MAILAODRE55 CIiV ZIP f'NONE LICENSE• <br />�.�nao.., ......,. <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ �EMOLITION ❑ VdOODSTOVFJFRPL INSERT BUI�DING RELOCATION <br />TENAYTIMPPOV[MENTOf�INt[RIORREMO�ELONLY GONiACTPER50NPNOPHONENO. �3�p . ?f.�7L ��"�'� <br />��ti��l�-�^ � .l <br />/!!\ n�.,n�. 4.L, l 2�/y-i��l`�'� f'�.VIiIL <br />PPILE OF WONK <br />ioi.2� J B�Ocn � oF <br />� � <br />PROJECTPODAE55 <br />5 u �-I. <br />PLUMBING <br />NO. TYPE OF FIXTURE G.-1 ITEM <br />—f WATER CLOSET (TOILE� <br />/ BATNTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINKB DISP. _ <br />DISHWASHER <br />LAUNDRY7RAY _ <br />OPINKIN� FOUN� <br />FLOOR DRAIN <br />Bl+CKFLOW PFiE\ <br />ROOF DRAINS — <br />SINKISERVICE— <br />Zp ' <br />p � I <br />I�� <br />OF CONST <br />4\'ABLNAGT A _ � <br />oFoioc <br />�S S.r <br />'4']5 (nhKh4. <br />SPRINrcI[RSPEOUiRED " <br />.IG4TION ACC OY <br />� � <br />� <br />._ . y— <br />SUBTOTAL S <br />PERMIT g <br />TOTAL FEE 5 <br />i5E104CK SIOESETBAC; <br />v' <br />APER VAWN IT[ <br />� bOO � �vES :: NO <br />�ies3esMr. occ��i <br />❑r <br />�� <br />I HEREBYGERTIFV THAT I HAVE REA�AND E�AMINED THIS AP'LICATION AND <br />KNOW'HESAMETOBETFUEANDCORRECT.ALLPROVISIONSOFLAWSAND <br />ORDIKANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPEGIFIEDHEREINOP NOT THFGRANTINGOFAPERMIiDOESNOT <br />PRESUtdE TO GNE AUTNORIN TO VIOLATE OR CANGEL THE PROVISIONS OF <br />ANY OTH ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER� <br />FORMANCE OF CONSTRUGTION. THAT I AM AUTNORIZED BY THE OWNER OF <br />THIS PROPERTY TO PE(7FORM THE WORK FOR N'HICH APPLICATION IS MADE <br />AND 1 COMPLV WITN THE STATE CONTRACTORS LAW 18..^7 RCW AND <br />296200 W>C. U <br />SIGNALUR[OFCONiPAC10RNi:lIll�ORqE�AG[Nt DAi6 7�2.�-L,�1 <br />X �'l��-�...«.. I-� . <br />��� � <br />APPLICANIS CIl Y 13114.�N[Sl t IGNiSC NO FND OOSINE55 Nnld[ <br />MECHANICAL <br />ryp, 7YPE OF EOUIPM1 <br />NC— PJ��NDLG UNITS— H.P. <br />FORCED AIR SVSTEMS— 9T. <br />UNITHLATERS—BT.U. M <br />FAN <br />FI REPLACE 8 <br />ACEINSERT <br />PIPING <br />AUSTFAN <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />� FEES <br />BUILDING <br />PLUMBING __ <br />M1IECNANICAL <br />OTHER <br />STATE B ILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M EA <br />S <br />5 <br />5 <br />� l� <br />FEE <br />