Laserfiche WebLink
APPLICATION <br />FOR CONSTRkoCTION <br />PERMIT <br />fll0 Ew,y v0 <br />Lll'IPD <br />C.1Y OF <br />everett <br />BUILDING DEPARTMENT <br />TO BE COMPLETED <br />IN INK— PLEASE PRIN T <br />H 0 <br />259-8810 <br />E rj <br />OWHER 1 — MAILADDRESS <br />CITY <br />p <br />11 ♦ <br />' 'V_ - — - <br />a H <br />y y y <br />TEST WILAODRESS <br />p ZR• PHONE <br />r — <br />/He �� S3y-S�S�_ <br />y <br />I <br />ARCNR RDESIGNER MAILAOORESS <br />C.ZI/P �/ PHONE <br />- <br />1'y�� <br />I1ri'T L �T-V� �"IE1 fY��\ <br />// <br />S ��� f"IQ✓27//� I!.' 5Yn Ci,O�rLNSEry Jaz <br />n•� \IBC <br />CITY <br />I..I <br />DENTAAC�O-R AUIIIDDRESS <br />(A H <br />MECHUMICALCONTRAGTOR MAILADDRESS OV Ll-) CITY SIP PHONE LICENSE <br />OH <br />� <br />L 'S <br />Hb <br />PL MMN NTRACfOR LAODBEBS <br />CRY 21P PHONE LICENSE <br />CASSOFINORK <br />❑ <br />LPJ NEW ❑ ADDITION ❑ ALTERATION Ll REPAIR ❑ <br />DEMOLITION ❑ WOODSTOVEIFRPL INSERT SUILOINGRELOCATION <br />I' <br />ty <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTACTPERSON AND PHONE NO <br />f <br />HH <br />S 'DG eU <br />�yI DZ <br />CONTRACT PRICE OF WORK <br />IJ H <br />DESCRIBE W9RK AND SOUAREfWTAOEINVOLVED <br />y i En <br />Q <br />Y `L¢E C� i <br />CC+�7��--II <br />PBOIroBEOUSEOFBDILDINo <br />IHEREBY CERTIFY THAT IHAVE READ AND EXAMINED THIS APPLICATION AND <br />F <br />'z � <br />KNOWTHE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWSAND <br />y <br />1 3 p co <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />LEGALDESCRIPHONOF PROPERTYISHOIN BELOWORATIACH FOUR CORESI <br />WHETHERSPECIFIED HERENOR NOT.THEGRANTINGOFAPERMITDOES NOT <br />LI <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />BLOCK OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER - <br />a <br />S LOT <br />FOR MANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />288.200 WAC <br />SIGNATURE OF CONTRACTOR OR AUTHOROED AGENT DATE <br />V. RM1l�I�C\f\0 <br />APLI <br />PROJECTADDREW <br />CITY BUSINESS LICENSE NO ANUBUSMES9 NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO, TYPE OF EQUIPMENT <br />FEE <br />g <br />WAI ER CLOSET(TOILET)A/C—NHNDL6 <br />UNITS—H.P. <br />FORCED AIR SYSTEMS —BTU. MEA <br />C / <br />BATHTUB <br />Ili <br />ti <br />LAVATORYIWASH BABIM <br />UNIT HEATERS—B.LU M <br />� <br />SHOWER <br />CLOTHES DRYERS <br />_ <br />Et <br />1 <br />KITCHEN SINKS DISP. <br />VENTILATION FAN <br />_ <br />� <br />I <br />018HWASHER <br />RANGE HOOD <br />�� <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />METAL FIREPLACE S CHIMNEY <br />URINAL <br />BlowDRINKING <br />FOUNTAIN <br />FIREPLACE INSERT <br />-v1 <br />1 <br />FLOOR DRAIN <br />HEATPUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUSTFAN <br />_. <br />- <br />6=1 <br />SINK(SERVICE—BAR ETC) <br />; <br />1 <br />SUBTOTAL $ <br />SUBTOTAL $ <br />--_--- <br />�. <br />PERMIT S <br />PERMIT $ -. <br />TOTAL FEE S <br />TOTAL FEE S - <br />FRONTSETBACK BEAR SETBACK SIDE SETBACK <br />PUN CHECK NUMBER FEE RECEIPT NO. <br />\\ <br />USEZONE LOTAREA VACANT SITE <br />FEES <br />VALUATION <br />_FEE <br />❑ YES D NO <br />BUILDING <br />TYPEOFCONST. OQOOPANCYDROUP NO.OT OWELLINCIUNITS <br />--- - - <br />- <br />--- <br />ALLGWABLVACTUAL <br />PLUMBING <br />SIZE OF BLOOD, NOOFSTORIES BBMT. OCC LOAD <br />MECHANICAL <br />DY <br />ON <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REWIRED OYES ONO <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPLICATION AGO aY PLANS APPR eY <br />TOTAL <br />