Laserfiche WebLink
`,IIILPPLICATION FObs1 TY <br />A•E"'°'"" <br />CONSTRUCTION 0 <br />IM1 OF <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK • PLEASE PRINT <br />259•8810 <br />❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />] DEMOLITION Li COMBINATION <br />w�1Ep <br />Hell AftpnE sS I C'+% 1ctl (I <br />TIP PHONE <br />! C �IL <br />city <br />TIP ONI <br />IIf.11HL61 I'll'JI Mtlnl N <br />Mell eDDPE99 <br />A Rf PAI CC91nAQpn <br />MAII I-0ORE9S GItY !IP PIIONI LICENSE <br />of lIIA1UCAlCMp NLIT MAIL ADDniss CITY (. ZIP M10NL LICl RISE <br />jn �PIIONt <br />\�I'L(y1 �IyCJ'/4n/11 <br />1'lUM" gl„Ij CO111 <br />gGtOR <br />MAR ADDFIISS GHY !11• PnONE lKL .L <br />':I ASS Of WOnv - -- <br />❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVElVRPL INSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION <br />pl/J bliptl' WON n'OS��y <br />Llni�'� <br />MArI nul!11•WB VPOpI <br />IL l 1 <br />'lt5GR10t. wnnK <br />1 <br />! �«: �.. <br />Jseyr nvnonla <br />I HEREBY CERTIFY DOIJ I HAVE READ AND EXAMINED THIS AP' <br />PLICA I ION AND KNOW( -HE SAME TO BE TRUE ANDCORRECT. ALL <br />PpaPLP1Y 15r1UwV nELOW OR Al1AC11lOUR COPn 51 <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LInAL OESLpIPNON OE <br />�F WORK WILL BE COMPLEIED WITH WHETHER SPECIFIED HERE- <br />" OR NOT. THE: GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PER17ORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CON TRACT014 OR AUTHORIZED AGENT DUE <br />X (J �7 <br />-� <br />APPLIC.ANT. If BUSINESS LICENSE NO <br />Pp/a,J,E Cc�f" //AD ��"�T"S (�,. <br />(o bl. o ' v<JI_ <br />1 <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. <br />TYPE OF EOUIP 'ENT <br />FEE <br />ILO• <br />TYPE OF FIXTURE OR <br />ITEM <br />WATER CLOSET I TOP. EI I <br />A/C — A/HNOLG UNITS — H P <br />REFRIGERATION UNITS — HP EA. <br />BATHTUB <br />BOILERS — BTU /H P <br />LAVATORY (WASH BASIN) <br />' <br />GAS FIRED AC UNITS — BTU. <br />SHOWER <br />FORCED AIR SYSTEMS — B T U J M EA <br />KITCHEN SINK 6 DISP <br />WALL HEATERS —B T.U. M <br />DISHWAS4ER <br />UNIT HEATERS — B i.0 M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />-- <br />CLOTHES WASHER <br />CLOT( TES DRYERS <br />URINAL <br />VENTILATION FAN <br />PRINKING FOUNTAIN <br />RANGE HOOD <br />FIOOR GRAIN <br />WATER HEATER <br />BACKFLOW PRF_VENTEnS <br />PDOF DRAINS — RAINLFADERS <br />WOOD STOVE <br />SINK (SERVICE — BAR ETC) <br />METAL FIREPLACE S CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />OAS PIPING <br />EXI/AUST FAN <br />SUBTOTAL <br />SUBTOTAL <br />i <br />PERMIT <br />{ <br />PERMIT <br />TOTALFEE <br />{ <br />TOTALFEE <br />PLAN CHOCK NUMBER <br />FEE <br />RECEIPT NO. <br />_ <br />I IRIg15{InA1'r <br />nEM+GUBALrI <br />SIDE <br />SETBACK <br />USE 11JNt <br />Inr ARIA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />❑vE5 ONO <br />BUILDING <br />S <br />TYPt OF cuNst <br />Xj UPANCY GROUP 110 <br />Or Dwf{LING UNITS <br />PLUMBING <br />sVTrnUI a D9 <br />Nn ILA slOmE3 <br />MAX OCC LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REGURED OYES <br />U NO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />Ull "ILlln!I At:, n• <br />APPR FOP ISSUANLt er <br />PUBLICWORKS <br />11,111SCIRECKEDBr <br />TOTAL <br />PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS <br />