Laserfiche WebLink
• APPLICATION FOR CONSTRUCTION PERMIT 4E,, <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> • <br /> • HEATING SYSTEM: INI GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> • <br /> rl DEMOLITION f/�,.,COMBINATION/_ /�/yI I BUILDING <br /> y� ❑MECHANICAL O PLUMBING r_l SIGN <br /> OWNEF�/}lf mme ILADDRESS3(,07 G'C�/67 /I.1/I'e(V !O ZIP / PHOE9-o03 -339-0/23 <br /> ��tdes'ii�)r-ern aJlb. Q <br /> TENANT J� , �' MAIL ADDRESS CITY ZIP PHONE <br /> • ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONT ACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE II <br /> Seib <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PI IONE STATE LICENSE a <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE -STATE LICENSE E <br /> CONT CT RICE OF WORK <br /> /P9,© • 8v <br /> DESCRIBE WORK AND SQUARE FOOTAG INVOLVED CONTACT PERSON AND PHONE NO. • <br /> Gvii-i11) /rn/rr�/ rot, <br /> /%/#7 70)-0�J/( d- p 4/7`Siee , pi7r.�jr7S <br /> /0c /�f,74-__y,�J.�- // I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOS/D US OF BUILDING r/ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> • '1e�74 97`r 04,-e PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE AL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BL K OF• AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��L _/ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> `�� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRACTORS LAW 1:.27 RCW, 1 '96.200 WAG. <br /> CONSTRU TI N LOAN LENDER.ADDR S,TELEPHONE NUMBER <br /> dhe /'d - .x ///v- ?1$ <br /> PROJEC epDRESS �'/ems A/e,� DATE <br /> 0 �/6(/) /'� !/ CITY BUSINES NSE NO./L' <br /> PLUMBING /// MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> Z. WATER CLOSET(TOILET)4/e.1 A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> - LAVATORY(WASH BASIN)o`//Ls,,SW UNIT HEATERS-B.T.U. M <br /> SHOWER op/ CLOTHES DRYERS <br /> / • KITCHEN SINK&DISP �� 3 VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ( 5 <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> • BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> SUB TOTAL $ SUB TOTAL $ <br /> ' PERMIT $ PERMIT $ <br /> TOTAL FEE $ ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHICNI FE RECEIPT NO.vi <br /> vs_ <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING <br /> TYPE SF CONST. NO.OF STORIES OCCUPANCY NO.OF DWELLING UNITS <br /> GROUP PLUMBING .. <br /> SIZE OF BLDG. FIRE SPRINKLERS REQ'D BASEMENT MECHANICAL <br /> ❑ YES ❑ NO <br /> OCCUPANCY LOAD FIRE ALARM RECTO HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> • <br /> OTHER <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> • INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />