Laserfiche WebLink
APPLICATIUM FOR CONSTRUC11.ON PERMIT <br />Irre EmvmW <br />CRY Of <br />everett <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />I HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ __ <br />259-8810 <br />DEMOLITION <br />"COMBINATION <br />BUILDING /MECHANICAL <br />/PLUMBING SIGN <br />071Y�11ER <br />MAR ADDRESS <br />crtr !m— PNONE <br />is 9, OY Pf'SNL Yi0 i <br />Sfr9/�F ST A/�E f!/�T %�zo3 <br />2 s Sin 5� <br />IIENWT <br />uAt AEGRESS <br />Cm Zrr MIENS <br />sf%/77 <br />AK.ItCTORDESgKR <br />Df/y.,0 L,/ ei <br />MAX ADDRESS <br />G'r^ �1pC'G�/TEC <br />CI1Y ZIP RNDNE <br />//2o2-✓E /yeA"/.Q.fCA,VO N/.f 9B�3Y yg82�3 <br />OENERALf AACTDR <br />MAE ADDRESS <br />cT' ZW MADHE <br />LICENSE. <br />.o rLlN2 P <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CIEY ZIP MACAF <br />EICENSE. <br />RWBMGCMTRACTOR MAILADDRBSS CITY ZK MAXIMAL LK.ENSE. <br />CLASS OF VADRA <br />NEW -'ADDITION �_ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />COITRACi PACE OF YIORt <br />CAIREAjCi PFfl50N AN01'NOIIE N(�J <br />R/JNO�V /�f/,T/,L 2 5-73leY <br />w.'xx.'AM.I SpMANFIWIADE MVIXV[D eS% <br />QN 9NO Fnoo E7H-E'it� <br />%5'9 i3JC <br />RociPoscri List DF BUEDIxa .- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION 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 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW 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 296.200 WAC <br />SK.NATMRF OF C0NTRACTDI OR AUTNORRED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY IBNONN EXUGVI R ATTACH FOIRCOFIESI <br />Lot 2� SAM' OF ig"?ILIB y/ �T3 <br />QEG OAQpF.O N OG Io D ` <br />�j C f <br />L/iT 7 TFC ��d/ o <br />PN'JIECi /DCN[5s <br />/ J <br />MRSANTS III 1111111111111111 Tq AlIp 1115W[54NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO, <br />TYPE OF EOUIPMENT <br />FEE <br />Z <br />WATERCLOSET(TOILE T) <br />p . <br />AC—AHNDLG UNITS—H.P. <br />1' <br />BATHTUB <br />,e ; <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />LAVATORY (WASH BASIN) <br />/p <br />UNIT HEATERS—BT.U. M <br />SHOWER <br />f; <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />f <br />VENTILATION FAN <br />J <br />DISHWASHER <br />RANGE HOOD Af, i�— <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />--y—'r— <br />) I <br />WOOD STOVE <br />_ <br />_ <br />URINAL <br />METAL FIREPLACE A CHIMN <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS P,PING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE --BAR, ETC.) <br />SUBTOTAL E <br />SUBTOTAL E <br />PERMIT E <br />PERMIT E <br />TOTALFEE $1 <br />TAL FEE E <br />FOR OFFICE USE ONLY: __TE-o ,cc <br />ERJNTBEIBICA <br />F <br />�Y7/�) <br />RE AR SE1B.01( <br />A <br />BRIE SE)BACK <br />S <br />RAN CHECK NUMBER <br />90 2G082 <br />II E�/� Jr'p <br />a !•• <br />RE 1,74 <br />O <br />USF.Z <br />IWcµlE, <br />�j <br />VACANT SITE <br />A` G <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />C S r � <br />TYPE OF ENS AUMMIf <br />X -.I <br />T p [pI51 .ClUY <br />Y_N <br />rtnmAD <br />w V PFnuxIR'. <br />PLUMBING <br />a ; <br />sME O BL <br />lop-#f .ANY <br />NO OF F"'B B <br />BASEMENT <br />MECHANICAL <br />ADDITIONALPIANLM <br />�.�r ; 60 <br />OLCIIP.NCY OW FIRE SPITNIG. R[OD NEgNiIMRAi <br />NB <br />RUBGN FOR 4PBIMLERS <br />OTHER <br />�— <br />— <br />STATE BUILDING SURCHARGE <br />MAKE BY <br />RNRBAPPfgKBBY <br />�y <br />o <br />DITYOFEVERETT <br />LOCAL SALES <br />TAX CODE 15 3105 <br />PUBLIC WORKS <br />TOTAL <br />S O <br />