Laserfiche WebLink
APPLICATIOr1 FOR CONSTRUCTrJN PERMIT <br /> CITY OF EVERETT• BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVEREIT, WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION O BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: z7��S C.OGB�/ ��/F <br /> a�r SIIiG'fbhl� �a, a� szm� r-��;e� 5'�azo, zs5-y3s�{ <br /> ONHER MAIL�DDiI 55 �Itt ZIP pMONE <br /> IEN�NT MNLAOdiE55 GIIY !IP PIIONE <br /> ����Nnc�' �,��,/K <br /> �RCNITCGT OR DES�GNER MAII�DDf1E55 Gltt IIP PHONE . <br /> GrENEMIGONipALTdi M�ILADDRESS �IIY plP� PIIpNE SUTEUCENSE� <br /> Gsy <br /> M�ECNANICA�CONTR�CiOR Ma1lAbDNE55 CI1V ZIP PIIONE ST�TEIICENSE� <br /> PLUMBMGCONiNACTOR M�ILADDAESS CItY ZIP P110NE ST�iEUCENSE� <br /> C TfUCi VPoCE OF VIdiK <br /> /�� •°a- HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br /> DESCRIBE YNfiK�ND SOUARE FOOT�GE INVOLVED CONT�CT FCRSONANO PHONE HD��l zsZ_3���{ <br /> LL {f C C� O c <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED TNIS <br /> hPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF BUILDiv6 PROVI510NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �NK�GfI'�CES WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEG�l0E5CPIPTIONOGfqippEp7y($�qWNBELOM/q1�TTACNTWOGOPIES) NOT. THE (3RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior .,oiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHEA STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMCfL TA%1.0.M/MBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTHIICTIOHLOu1LEN0Eq,A00RES5.TEtEi'NONENVAIBEN ����j' ��� /O�/J� <br /> SIfiN�tURE � DA7E <br /> / <br /> CITV BUSINE55 tICENSC NO <br /> PWMBING MECHANICAL <br /> NO. TYPE OF FlIfTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—AMNDLO UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATEFS � <br /> KITCHEN SINK 8 DISP � CLOTHES�RYERS ' <br /> � <br /> DISHWASHER � RANCaE HOOD � <br /> UUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT�WOOD BURNING) i <br /> FlOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; . � : <br /> SINK(SEHVICE—BAR,ETC.) � GAS PIPING � i <br /> . <br /> _ <br /> EXHAUSTFAN ` - " <br /> i � <br /> � � <br /> r � <br /> � � <br /> � � <br /> `.iUB TOTAL 5 ; SUB TOTAL S ! ; <br /> PERMIT S � PERMIT S � � <br /> TOTALFEE S ' TO7ALFEE S —� <br /> FOR OFFICE USF ONLY: <br /> FpONTFETB�CK AE�.SE7B�CN S�DESETB�CI( 1'l�NC11ECNNUMAFfi fEF RECEIPTNO <br /> USE ZdIE LOi�RE� veceNt site FEES VALUATION FEE <br /> ❑YES ❑NO OUIIDINC � <br /> HEIGNT UMIDITION Hp pF OWElUNO 512E OF BLOGRI i <br /> UNIfS PLUMIIING i <br /> � <br /> OGCRC��N(:Y iq 0[SIMIICS OCCUPANTLOAD BASEMENT MECN�NIC�I � <br /> ❑YES ❑NO i <br /> FIRESPRINKLENNEO'D RE�SON �DD1110NALM�NCNfGK <br /> � <br /> OiHER � <br /> FIFEAWIMREOD pE�50N � <br /> S1AlE IIUIlUIN6 SIIRCN�OC•E <br /> ' �_ <br /> trreovr,onsr PLANSAPPROVE�BY CITYOFEVERETT PIIfl11f,WO�KS <br /> LOCAL SAIES --'— <br /> �nrE TA%CODE IS 3105 TOTAL <br />