Laserfiche WebLink
_ �.__�� <br /> ,�t-i _ � J 1 S� <br /> �� 35�� Q,PPLICATION FOR CQ�►`.!s fRUCTIdN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SION <br /> PROJECT ADDRESS p/ r <br /> ;�����`��—i7'�'C�"-�'Ll�`vt.c-T-� <br /> OWNER MAILpDDRESS CIN ZIP PNONE <br /> � ��S (4U�o Lc�. (�- su.,:t� am� 6r.�c . k� (oN5•K� <br /> TENANT M4ILRDDRE55 CITY ZIp PHONE <br /> ARCHITECT OR OESIGNER MAIL ADORESS CITY 21P PMONE <br /> Sd-/�G a�,i� LRJYIW _ <br /> GENERI.lC9NTRACTOH MAILR�DRF.SS CITV IIP PHC.�E STATELICENSEI <br /> tra-mc �� �n,rnw Ca)t.t,NT�'�E o�- ►c�M3 • <br /> MECHANICRLCON�AACTOR MAILADORESS CITV =IP PHONE STATEIICENSE� <br /> PLUMBING CONTRRCTOR MAILAODRESS CITV ZIP PHONE STATE'_ICENSE� <br /> CONTRACTPRICE OF WORN <br /> HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK ANO SOUARE FOOTAGE INVOWED C NT CT PERSONAND°110NE N0. <br /> Yl[.L� f.�jYL�Lu��.,m � �Q-t.um.�1c �0�•8/�-- <br /> � .3 i�1 � -, n �Lc�s (o�fq.8/a3 _ <br /> ' �l I HENEBY CERTIFY THAT I HAVE READ AND EXAMIPJED THIS <br /> APPLICATION AND KNOYJ THE SAME�O BE TRUE AND CORRECT.ALL <br /> P OPOSED USE OF BUILDINS FR PROVISIONS OF LAWS AND ORDINANCES OOVERNINU THIS TYPE OF <br /> - WORK WiLL BE C^'''PLIED W!Tf! WHETHEH SPECIFIED HEREIN OR <br /> LEOALDESCRIPTIONOFPROPERTY�SHOWNBELOW A7TACMTWOCOPIES) NOT. T!st 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO QIVE <br /> ioT I BLOCK oF t . �+'�' AUTHORITY TO VIOLATE OR CANCE!. THE PROVI310N OF ANY <br /> D� y OTHER STATE OR LOCAL LAW RE�ULATli!0 CONSTRUCTION OR THE <br /> PERFORIAANCE OF COtdSTRUCTION.THA�I AM AUTHORIZED BY THE <br /> � OWNEfi OF THIS PROPERTY TO PERFORM ?H� WORK FOR WHICH <br /> �313� - ODJ �f — O�j� U APPLICATION IS MADE AND I COMPLY WITH THE ETATE <br /> anace�rnu i.o.r+uMsen � CONTRACTORS LAW 1827 RCW AND 298200 ViAC. . <br /> . L 1(� <br /> CONSTRUCiION LOPN LENDEP.PDDRE55.TELEPHONE NUMBEfl x Q J�/%� <br /> ; SIGNRTURE ,1��� � OeiE <br /> .+ <br /> lJ <br /> GTV BUSINESS LICFNSE NO. <br /> F <br /> � PLUMBIN6 MECHA::ICAL <br /> � NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM FEE <br /> � WATER CLOSET(TOILET) A/C—AMNDLQ UNITS—H.P. � <br /> 2 BATHTUB ; FORCED AIR SYSTEMS•—B.T.U. M E.A. ' <br /> J` LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP � � CLOTHES DRYERS ' � <br /> DISHW� 'HER � VENTILATION FAN � <br /> LAUNDRY TRAY ; RAN6E HOOD ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRIiVKING FOUNTAIN i METAL FIREPLACE(WOOD BURNINCa) i <br /> FLOUR DRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE i <br /> SINK(SERVICE—Bl.R,ETC.) � QAS RANGE � <br /> ' GAS PIPING ' <br /> � � EXHAUST FAN � <br /> i � <br /> i � <br /> i � <br /> — � � <br /> � SUB TOTAL $ —; SUB TOTAL S ' <br /> PEHIriIT $ i PERMIT $ i <br /> TCTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAP SETBACK SIDE SETBACK PUN CNECN NUMBER FEE RECEIPT NO. <br /> zS' Z.S /S o 7•S .�7�� ) � <br /> vse z4� LOTAREA vncarvr s e FEES VALUATION FEE <br /> f`-S Z� ' es n No � �ui���Nc 3y Zl r .� , <br /> HEIG�4lIMITATIOIJ N0.OF DWELIJNG SIZE OF BLOGRI. <br /> �� ' UNITS � '3 � SF � �RA4 j' PWMBING ��� <br /> OCCUPANCY 110.0�'STOalES OCCUPANTLOAD BpSEMENT MECMANICRL , <br /> OROU <br /> p•3 u- 2 ❑ves No � <br /> FIREAIARMREO'D HEASON ADOIT10NAlPLANf,HECK i <br /> OTHER <br /> FIRE SPRINNLER REO'D REASON I <br /> STATE BUILDING SURCMARGE � <br /> TYPE OF COkST °LANS APPflOVED BY CITY OF EVERETT 7UBLIC WORKS � � — <br /> � � i ��' LOCAL SALES � _ <br /> L�ATE 2 2z S TAX CODE IS 3105 TOTAL � + <br />