Laserfiche WebLink
� <br />APPLICATILN FOR CO�I�TRUCI.ON PEFiMlT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />(S{ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS <br />mni�nvvntns CIfY ZIP PHONE <br />; c K� h /� � �-!l `/ f�'� � ltit,zw��o �, o�/� 5' 8G � y . <br />..... .,. ,-�„nt <br />ARCHITECTORUESIGNER MAILADORESS CIN ZIP PHONE <br />�o�n.�- H. �E� iSso ry�fti,q�,2 p..,e�euuc 9�� 7yG-y677 <br />GE,NrE�RA�L jCONTRACTOR �7PILAODRE55 CITY ZIP PNONE STATE LICENSE Y <br />l.lD/L1l=x/ %ve%n.�,,,� {�•0/� X�� �e � r/'�'27� 31/7-yStiv OR2cP�SsR <br />MECHANICALCON7RACi0R MALA��RE55 CITV ZIP PHONE STATEUCENSEN <br />PWMBINGCONTRACTOR MAILAODRESS CIN ZIP PHONE STATELICENSEM <br />LOT <br />�� <br />ir+vo�veo <br />A <br />' PROPERN (SHONRJ OELOV/ Ofi ATTACH TVJO <br />BLOCK OF <br />PAf1GELTAX I.D. NUMBER <br />� 9a7 av 1 0�3 p yp3 <br />CONSTRUCOON�OPNLENDER,ADDRESS,TELEPHONENUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATOf"'(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />F(70NTSETBACK REARSETOACK <br />USEZONE IL07AHEA <br />MEIGHTLIMITATION I NO.OFDWELLING <br />U�1T5 <br />OCCUPANCV NO.OFSTORIES OCCUPANTLOAD <br />otir=_ <br />FEE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTqCT PERSON ANO PHONE NO. <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOaK INILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />!JOT. 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 TI1E <br />PERFORMANi.E OF CONSTRUCTIJN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FO'ri WHICH <br />APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />SONTRACTOIj$ LAW 18.27 RCW AND 296.200 WAC. <br />CITY OUSINESS LICENSE NO. <br />NO. TYPE OF FIXTUflE OR <br />A/C —A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T. <br />HEAT PUMP <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />METAL FIFiEPLACE i <br />FIREPLACE INSERT <br />G�5 RANGE <br />GAS PIPING <br />SIDE SETBACK � Pll�N CIIECK NUM�ER <br />VACANT SITE FEES <br />❑YES ❑ NO pUI1.01NG <br />SIZE OF OLDGRI. <br />PLLIMOING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL F'AN CHECK <br />OTIIER <br />STATE BUILDING J�1RCHf .7G'c <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />fEE <br />M <br />PERMIT S <br />TOTALFFE S <br />RECEIPT NO. <br />FEE <br />■i <br />