Laserfiche WebLink
APPLICAT14.1 FOR CONSTRUG?.JN pERMIT <br />evemtt <br />Iha Eve�g�oun � <br />C�TY OF <br />�everett � <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />I I DEMOLITION I I COMBINATION I/�BUILDING I I MECHANICAL L I PLUMBING �_i SIGN <br />own�n unaeooisss cnv zir PIIONE <br />�J��Toa Q��p�seu )3oK MLDo,.i�� tueKen 95ft o� 2S2 -$'1 g 1 <br />T[N�NT MAII ADOPESS GITV ZIP PIIONE <br />�RCIIITECT OB DESIGNER <br />CITY <br />�` s�-5 e � <br />N(.�ERALCON7P4CTOR MFILADONE55 CITY 21P PMONE IILENSE� <br />UlcroR. �. AeuCe.svw+ SA-�+�.�- VICTo ►� �y3 GZ <br />l,fEf,H�NIC�LCONTRACTOR MAILADORESS GITY 21P P110NE LICENSE� <br />ZIP PHOHE �� I � S ��ZT L <br />�'(�t•3 3�3-GC�e <br />PlUM61NGCONTO�CTOfl MAILA��RE55 CITV 21P P110NE LICENSE/ <br />IIiA�TG. �'e�acT F�caMgi�y _ 3�S-i9YZ <br />ClFS FWORK <br />I NEW f 1 ADDITION I 1 ALTERATION I��l REPAIR ❑ DEMOLITION f I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TEN�NT IMPflOVEMENT OO INIEfl10R IiEMOD[L ONLY I CONiRCi P[RSOI! RND PIION[ NO. <br />CONipACT PPIC[ OF WORN: <br />DESCRIOE WORK �NO SIX1�F <br />0 E� S <br />PROPOSED USE OF B IIDING <br />1 EG�L DESCRIPTION OF PROPF <br />iot__� o�ocK <br />rmu�cr <br />OF <br />LAUNDRYTRAY <br />CLOTHES WASF <br />URINAL <br />DRINKING FOUP <br />FLOOR DRAIN <br />BACKFLOW PRE <br />ROOF OFiAINS- <br />SINK (SERVICE- <br />cories� <br />OF <br />I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PRUVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE 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 />PEFFORMANCE OF CONSTRi1CTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPFRTY TO PERFORM THE WORK FOR WHICH <br />APPL�CATION IS MADE AND I COMPLY WITH THE S1ATE <br />CONTRACTORS LAW 1827 R(:CJJ AND 296200 WAC. <br />SIGNATUREOFCONTfl�CTOiiORAUT110PREDAGENT D�TE <br />��is�i'� �-C��� - / �- lY -�i �� <br />RPPIICANIS CITY OUSINE55 UCENSE N0. AND BUSMESS NAME <br />OR ITEM �EE NO. TVPE OF EOUIPMENI <br />� ��- A/C-A/HNDLG UNITS-H.P. <br />;�- FORCED AIR SYSTEMS-B.T.U. <br />� UNIT HEATERS-B.T.U. M <br />1r 'f� CLOTHES DRYERS <br />^'- Z VENTILATIONFAN <br />n <br />�� Tj RANGEHOOD <br />ICHId� <br />F001lf5lIOACN �EAq5E70/C� SID[SEipACI� <br />�.. / � _ S <br />IISE 2011 <br />�� <br />IYP[ OF GONSi. ALI OWABIE <br />]�'-/J <br />SIZE OF BI.DO <br />0 <br />LSZY <br />OCCUPPNCYLOAD <br />!Z <br />RUSON FOB SPtlINNI[PS <br />l0T Af1EA <br />7 LSZ�a. <br />iYPE Of CONSi. ACNPL <br />TL -N <br />NOAF STORI[5 <br />� <br />FRE SPRNKlEfiS flE0'D <br />l-I YGS t?d NO <br />APVIIC�TION ACC.OY I PlANS RPPROV[O DY <br />��.! �..� <br />S.P. �3�U/ <br />VACRNT SITE <br />I 1 YES f I NO <br />aaneier xoam�Ywxcun <br />4NWP w <br />.^ <br />OASEMENT <br />I_l VES 1;7Rd0 <br />IIEIGIIT LIMIiAT10N <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CQDE IS 3105 <br />wvuu siwe <br />METAL FIflEPLACE 8 <br />FIREPLACE INSFRT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />P1RlCIIGCNNlIMO@p I FEE <br />FEES <br />oui�oiNc <br />PLUMOING <br />MECI IANICAL <br />OTI{ER <br />STAT[ OUILOING SURCHAflGE <br />STAif ENERGY SURCHARGE <br />PUBt u WORNS <br />707AL <br />L9 <br />SUB TOTAL $ I •��'� i� <br />PEflM1T $ J— <br />TOTAL FEE $ ,� � r <br />RECEIPT NO. <br />S! <br />VALUATION FEE <br />h/ /(A�J 1 !'.r�rY � <br />/� <br />� <br />