Laserfiche WebLink
APPLICATI�i�I FOR CONSTRUCI.ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION CI COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS � 0 _ /�./yJ <br /> `1 ' <br /> OWNER MRILADDRE55 CITY 21P PHONE �Z�.� Z <br /> � /338 1 - <br /> TENANT MRILADDRESS CIN ZIP PHONE <br /> _ 6 P.u,� i� ✓E S� E`,��E�"'P VMONE 3i� -s�oo <br /> �RCH CTORDESIGNER MAILAUDRE55 <br /> cm zir <br /> 6ENERALCONTRACTIXi MAILRDDRESS CITY ZIP PIiONE STATEl10EN5E� <br /> //T�� _co�sr ��s�//�UE s S�m�wq �sio9 G��r-�rsa cl,v iTcc�0 7��t' <br /> ��r Z�p PHONE STATEUCENSE� <br /> MECHANICALCONiAACiOR MA�LADDRESS <br /> - ��n, Z�p PHONE 57ATE LICENSE M <br /> PLUMBINOCONTRRCTOR MAILADDRESS <br /> �ry,�PRICEOFv�Oryc/�� HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> ��—` �/+/��- CONTACT PERSON AND PMONE NO. <br /> pE$CPoBE WORK ANU SO�ARE FOOTAGE INVOLVED <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PpaPOSED USE OF BUILDINO PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I�G--S7E��U� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � LEOALDESCPoPTIIXJOFPt:OPEHfY(SMOWNBELOWOFATTACHTWOCOPiES) AUTHORITYTOTVIOLATEAORRCANCEETHE PROVSION OF AINY <br /> � �pT BLOCK oF OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED��?HE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR .VHICH <br /> - APPLICAT ON IS MADE AND I COMPLV WITH THE STATE <br /> CONTRA O� S LAW 18.27 RCW AND 296200 WAC. <br /> P/JiCEL TAX I.D.NUMBER ��. <br /> // /�'�9y <br /> CONSIRUCTIONIOANLENUEFl,AW�7ESS.TE�EPHONENUMBER SIGNATURE ' 0 E <br /> CIT'BUSINE55 LICENSE NO. <br /> � pLUMBIN6 MECHANICAL �E <br /> � NO. TYPE OF FlXTURE OR REM �E N�� a�_,qMNDL6 UNITS REH.p ITEM ' <br /> � WATER CLOSET(TOILEn � FORCED AIR SYSTEMS—B.T.U. M E.A. �, <br /> � BATHTUB HEAT PUMP � <br /> LAVATORY(WASH BASIN) , UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP ' � <br /> DISHWASHER � VENTILATION FAN � <br /> � RANGEHOOD ' <br /> LAUNDRY TRAY ' � <br /> ' CLOTHES WASHER � WATER HEATER <br /> � WOODSTOVE , <br /> URINAL � METAL FIREPUCE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ' � <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS RANGE � <br /> � GAS PIPING <br /> ' EXHAUST FAN � <br /> � <br /> � � <br /> i ' <br /> � i <br /> i <br /> SUB TOTAL $ i <br /> SUBTOTAL S � pERM1T S � <br /> PERMIT S � TOTAL FEE $ r' <br /> TOTALFEE S <br /> FOR OFFICE USE ONLY: FEE RECEIPT NO. <br /> PUN CHECK NGZ7 <br /> FRONT SE7BACK REAR SETBACK ' SIUE SETBACK L� <br /> FEES VALUATON FEE <br /> USEZONE LOTAREA VACRNTSITE i <br /> ❑VES � NO BUILUING —� , <br /> i <br /> i <br /> HEIOHTLJMIT�TON NO.OFDWELl1NG SIZEOFPLDGRI. p�UMBING <br /> UNITS <br /> � <br /> � MELHANICPL � <br /> pOppp�NCV NO.OFSTONES OCCUPPNTLORD BASEMENT i <br /> OROUP . ❑YFS ❑ NO i <br /> ADOITIONRL PLAN CHECK <br /> FIREMMMREO'0 REASON � <br /> pTHER � <br /> FIRE SPP�NKLER REO'D REASON i <br /> STATE BUIIDING SURCHARGE <br /> ; <br /> TYPEOFCONST PLANSPP Pf�VEOBV �RyOFEVERE7T PUBLICWORNS � <br /> /�'�, LOCAL SALES I <br /> oATE/ - — TAX CODE IS 3105 70TAL ,L <br /> �\li�' <br />