Laserfiche WebLink
APPLICATII..� FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILOING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />C7 DEMOLITION fl COMBINATION fl BUILDING MECHANICAL 11 PLUMBING fl SIGN <br />PROJECT ADDRESS � 0�+9 .�� SY �'L SGJ , <br />OWNER � M�ILRDDRESS CITV ZIP PHONE <br />i � 's �L SW <br />3� 7- � 7s� <br />icnnm rnnRnOORE55 QTY ZIP PHONE i <br />AHCNITECT OR OESIGNER MAIL AODRE55 Cltt ZIP PHONE <br />GENERALCONTRACTOR MAILADDRE55 CIIY ZIP PHONE STRTELICENSE� <br />MECHANICALCONTRACTOR MNIADDRE55 CIN ZIP PIIONE STATELICENSE� <br />WORKAND <br />wr <br />BLOCK _ <br />PANCEL TNt I.D. NUMBEN <br />INVOLVED <br />CONSTRUC7ION LO�N LENDER. ADORE55, TELEPHONE NUMBER <br />pLUMBIN6 <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />OR ITEM <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />$ <br />FOR OFFICE USE ONLY: <br />FFONT SEiBACN REAR SETBACK SIOE SETBnCN <br />USE ZONE <br />IIEIGIIT �IMIiATION <br />OCCUPANCY NO OF <br />GROUP <br />fIRE ALARM REO'0 <br />wr <br />FEE <br />PNONE <br />HEATING SYSTEM: Ij�'GAS fl ELECTRIC fl <br />CONTACTPERSONANDPHONENO. ��E G�Z�SI�� <br />I NEREBY CERTIFY THAT 1 HAVE READ AN� E%AMINED 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 COMPLIED WITH WHETHEq SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANC[ OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE Ai.D I COMPLY WITH THE STATE <br />CONTRACTORS LAW /827 RCW AND 296200 WAC. <br />���� /..�-�__.-' z-9-�� <br />SIG TUR O�TE <br />CIT�' BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF EGUIPMENT FEE <br />A/C — AMNOLO UNfTS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />VENTILATION FAN � <br />RANGE HOOD � <br />Y�ATER HEATER � <br />WUOD STOVE ' <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPL�Cc INSERT (WOOD BURNING) � <br />GAS FIREPLACE ; <br />GAS RANGE � <br />GAS PIPING ' <br />EXHAUSTFAN � <br />SUB TOTAI $ <br />PERMIT $ <br />PIAN CHEGN NUM�ji _ � FEE I AECEIPT NO. <br />LOT�REA V�C�NTSITE FEES � <br />f I YES f i NO ypILOMf. <br />NO.OF UWELLING SIZE OF BLUO�II <br />UNIiS <br />PIUMpING <br />OCCUPANTLOAO BASEMENT <br />MECHRNICAI <br />fIYE$ 11 NO — <br />RERSON r1DUI110KAL PI.RN GN(.GK <br />(:THER <br />FEASIXJ <br />STAIE DUIt�INf.SURCHARGE <br />PLANSAPPPOVE�BY CITY OF EVERETT �lIBLIC WOPKS <br />LOCAL SALES <br />oATE TAX CODE IS 3105 TOTAL <br />