Laserfiche WebLink
APPLICATIQ-!�1 FOR CONSTRUCT�ON PERIVIIT <br /> 7� O� .%ITY OF EVERETT�BUILDING DIVISIOI. <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> O DEMOLITION O COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS _S� I (p .�-S� � �'C .-BO:t <br /> . <br /> O ER M'A`LADDRESS CIIY 21P PHONE <br /> ti�.�.,cvood hts�nw l�,l�-//o r� IZtd 12d #� aoor �.GLlozu lUA �5/�/-�3�3 <br /> TENAM MAIL/DDRESS CITY ZIP PHONE <br /> A Hi� ITECTORDESIGNEfl /�1 MAILAD�RE55 CITY ZIP PHONE <br /> Yw7rLl Qd V LIJ72!/l <br /> GENERALCONTRACTOR /�MAILADORESS CITV ZIP PNOkE STATEIJCENSEN <br /> �Q/1�t( � (JIwTY►�/'7 C oliN rr�� 1 o M� <br /> FIcCH/UJICRLCONTRACTOR MAILADDflES� CI7Y ZIP PHqNE STATELICENSE� <br /> PIUMBINGCONTRACTOR MAILAU�RESS CITY ZIP PIiONE STATELICENSEI' <br /> C7NTRACT PRICE OF WORK <br /> f �(3 f L.� U tIEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> D< PBEWORKA SOUARE AGEINVOL EO , ON ACIPERS l�'pPhNENO. �� �^ �/S� <br /> %i <br /> � .S� `j f 8 3 5 arla �A'�! �2 uha (i 5/ - l 7 <br /> g (��C � � C� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIlDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S F rL PROVISIONS OP LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGALDESCRIPTiONOFPROPEHTY(SHOWNBELOWORATfACHTWOCUPIES) NOT. THE GRPN'�INO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT �� ewcK oF_ � - AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY � <br /> n I ,1y� -�7- OTHEH STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> 1- EW P-!M')`LU � �I �-�I S �,JI.U� ,/L PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO?ERTY TO PERPORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE S'lATE <br /> PARCEI TAX I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �l 35 - �� O� — o I O X /�1�►�►�, L�i �M.� �1 d 3 l 9 S <br /> CONSTHUCTION LOAN LENDER.ADDRE55.7ELEPHONE NIlMBER <br /> SIGNATURE p�y a y� DATE <br /> CITY BUSiNESS UCENSE NO. <br /> PLUMBINO -MECHANICAL � - <br /> NO. TYPE OF flXTURE OR REM FEE NO. TVPE OF FIXTURE OR ITEM FEE <br /> WATER CIOSET(TOILEn � A/C—lUHNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> � SHOWER � UNIT HEATERS—B.T.U. M ' . <br /> KITCHEN SINK&DISP ; CLOTHES DRYERS � <br /> T <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRYTRAY ; RANOE HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL � WOOD STOVE ' <br /> DRINKINO FOUNTAIN � METAL FIREPLACE(WOOD BURNI G) p � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURN G) � <br /> BACKFLOW PREVENTERS ; GASFIREPLACE , <br /> SINK(SERVICE—BAF,ETC.) � GAS RANGE � <br /> ' OAS PIPING ' <br /> � E%HAUST FAN i <br /> i i <br /> i i <br /> i � <br /> i � <br /> SUB TOTAL S � SUB TOTAL $ ; <br /> ' PERMIT $ � PERMIT S � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SEfBACK J REM SETBRCK , E SETBACK i PUN CHECK NUMBER FEE �� AE�„pa�, <br /> �''' 7��' ��9� <br /> usez ✓� �or�a� VACANTSITE FEES VALUATION FEE <br /> ❑YES ❑ NO BUILDIN� •Z3� OZ ,� / T <br /> HEIOHTLIMITATION� NO.OFOWELLJNG SIZEOFBLDG/TJ. � <br /> UNITS $.3(>! S.P� L���^/�+ 1' pLUk91NG �i <br /> s - Gn�a�E <br /> OCCUPANCY NO.OFSi0NE5 OCCUPANTLOAD BASEMENT MECHANICRL <br /> GRO P <br /> -3 2 N n oYEs � , <br /> FIflEALARMREO'D REASON ADUITIONALPLANCHECN �}-� <br /> OTHER � � <br /> i <br /> FIflESPRINKLERREQ'U REASON - i <br /> STATE BUILDING SURCHARGE ( �r r <br /> TYPEOFCONSL PLANSMPF VEpBY CRYOFEVERETT PUBLICWORKS � -- <br /> �� LOCAL SALES � <br /> � ��J DATE Z�i(o 9 5 TAx CODE IS 3105 TOTAL � � I -- <br />