Laserfiche WebLink
: ��:. <br />1�;-.-� <br />APPLICA'TION FOR CONSTRU�GTION <br />PERMIT <br />th� Ewrprsan <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />269•8870 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />everett <br />e <br />MCHRECTOROE516NER M�IIADURE55 GitY 2iP PNONE <br />OENEMLGONiRACTON MML�ODFESS GiV ZIP P��ONE LIGENSE• <br />�I� ��� • GILY 21P 1'110NE LIGENSE • <br />MEGHANIGLLCONTPACTOR MMLAUOAE55 <br />PIUMBINOGONtH/�CTOR MnILADORE55 GIiY 21P PI10N[ UGENSE• <br />❑ NEW V� �ODITION ❑ p�TERATION ❑�7EPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLINSERT ❑ BUILDIN�RELOCATION <br />TEN/J1T IMGROVEMENT OR INiEfliOR R/E'M�ODEL ONIY ] C^ONGLI PEPSON �Np PIION[ NU. <br />mu�e�neeeV�C(lt\W1CN. .T.� /��"'�-`�- �� _I,),�I�w�vj{� ��r���• <br />LOT� tlLOCN OF <br />PLUMBINO <br />�O. TYP! OF FI%TURE ON ITEM <br />WATER CLOSET (TOILEn <br />enrHrue <br />LAVATORYIW�H BASIM <br />9HOWER <br />KITCHEN SINK6 DISP. <br />DISHWASHER <br />L�UNORYTRAV <br />CLOTHES WASHER <br />URINAL <br />ORINKINO FOUNTAIN <br />FLOOR DHAIN <br />BACKFLOW PREVENTERS <br />oMc nneius _ AnIN1.EA�ERS <br />SUBTOiAL S <br />PERMIT S <br />TOTAL FEE S <br />CN NE�R�SET`BI�CH SiDES <br />W • <br />LOTMEA MC�N <br />—Z � YE5 <br />St. OCCUP�NCYUNOUP NO.OF <br />1CTUAl�� .1 � � Z <br />�s <br />1�72 sF AAp I► li�� <br />FIPESPNINNLEPSfVE0l11PE� ❑ YES J�l NO <br />•PFLIC�iIONACGBY PUNSAiPR.9Y <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION nNo <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ANO <br />ORDINANCES GOVERNING THIS NPE OF WORK WILL BE COMPLETED WITH <br />WHE7HER SPECIFIED IIEREIN OR NOT.THE GRANTIN� OFA PERMITDOES NOT <br />PRESUME TO GIVE AUiHORIN TO VIOLATE OR CANCEI THE PROVISIONS OF <br />ANY OTHER S7ATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE PER- <br />FOAMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION I$ MADE <br />AND I COMPLY WITH THE S7ATE CONTRRCTORS LAW 18.27 RCW AND <br />296200 WAC. <br />SION�lUREOFCON111PC10110fiAU1HOPIZED�OENT D�iE <br />X � ' �:� <br />.�z-�(-8`� <br />�PPL �NISQfVBU51NE55lICENSENO�NDB � SSN�ME <br />MECHIINICAL <br />NO. TYPE OF EOUIPMENT <br />AIC — NHNDLG UNITS — H.P. <br />FORCEO AIR SVSTEMS— B.T.U. M EA <br />UNI7HEATERS—flT.U. M <br />METAL FIREPLACE d CHIMNEY <br />FIREPLACEINSERT <br />HEAi PUMP <br />GAS PIPING <br />TOTAL FEE S <br />FEE I/�, /7 NEC� Vf NC�� � ' <br />1.L � <br />BUILDING <br />OWELLIN� UNIIS <br />Z PLUMBING <br />��o MECHANICAL <br />� irn�nar+ OTHER <br />2� SiATE BUILDING SURCHAFGE <br />STAiE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />