Laserfiche WebLink
APPLICJ :''ION FOR CONSTRU"JTION <br />PERMIT <br />the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />x PAS-TIGr Foul' I&C-- <br />IENANI MAIL ADDRESS CITY ZIP PHONE <br />�a�b4 Cc ue C __j`_ Sq Aug r-Vky tt Apo 1 (1-60 R59- S,6Gq onIr <br />ARCHITEQ OR DE TONER MAIL ADDRESS CITY ZIP ONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY LP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAR ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBINU CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WOPK c0twtetw u e _ <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTO'✓E/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE VIOORRKK LLLANDD SQUARE FOOTAGE INVOLVED <br />PnDPOSED USE OF eInL INS <br />THEREBY CE RTIFV THAT IHAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT.THE GRANTING OF A PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THISPROPERTYTOPERFORMT14EWORKFORWHICHAPPLICATIONISMADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAS. <br />slcNArunE or coNTnnclon oR AunwnaED AGENT DATE <br />APPLICANTS CI tY BUSINE 55 L ICENSE NO AN[' BUSINESS NAME <br />EAL DESCRIPTION OF PROPERTY (SHOWN BELOW On ATTACH FOUR COPIES) <br />) O'� <br />LOT=—Iq�y1 L�BLOCK E., �I-R-Z In �U�.Yc,{, <br />SIIIAW� n Y1Q. W�h��_I_ QU�WLIS�_ <br />E� <br />`Q 0A1N <br />XCI84 Q" ue C�a��tl_LWf-9�S�iI <br />PROJECT ADDRESS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER Ct OSET(TOT LET) <br />ATC— A/HNDLG UNITS —H,P. <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS— BT.U. M EA <br />LAVATORY(WALSH BASIL'!) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />_ _ <br />_ _ <br />CLOTHES DRY'LRS <br />_ <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOODSTOVE <br />_ <br />URINAL <br />_ <br />METAL FIREPLACE A CHIMNEY <br />_ <br />_ <br />DRINKING FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />T_ <br />SUBTOTAL <br />E <br />_— <br />SUBTOTAL E <br />__ <br />_ <br />PERMIT <br />E <br />PERMIT <br />TOTAL rEE <br />E <br />TOTAL FEE _ E <br />FRONT SETBACK <br />REAR SETBACK <br />oUERETBACK <br />PLAN CHECK INMBFR <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />! <br />VACANT SITE <br />0 YES 0 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDIIJG <br />TYPE OF CONST. <br />A.LLOWASLFJACTUAL <br />R <br />OCCUPANOYGOUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE Or eLDR <br />NO OF STORIES <br />BSMT. <br />ITY <br />IT <br />OCC'.OAD <br />MECHANICAL <br />OTHER <br />rIRESPRINKLERSRECUIRED ❑ YES G NO <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACG BY PUNS V <br />— <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />--' <br />