Laserfiche WebLink
APPLICATIqN FOR CONSTRUCT&ON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT <br />))EATING SYSTEM: J GAS J ELECTRIC J <br />- <br />259-8810 <br />i - DEMOLITION //,I,L^/COMBINA1TIONpp � BUILDING <br />p {/ ❑ MECHANICAL (-1 PLUMBING <br />JJJ El SIGN <br />OYJNEj7 EZT m �_i Mll/ 11 ESS EV L.4�L I lJ ", It ' ClTyi t�,I-VI f ZIP q o PHONE /2 t," 1 & 1Fj I� (r L /jJ/ l/ J <br />TENANT MAIL ADDRESS Vj CITY ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE• <br />N AI l�l g <br />XFr6K <br />ESCRIB WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />/ <br />I HEREBY CERTIFY 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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUi HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIO IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTOR AW 18.27 RCW AND'196.2WP� <br />J � J <br />/ 1 <br />PROPOSED USE OF BUILDING <br />LEGAL. DESCRIPTION OF PROPERTY SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT - BLOCK OF <br />I� <br />PARC L TAXID. NUMBER <br />z — o3—ov—000??r <br />CONS RUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJE T A DRESS <br />Evil- r' e'c lti �I. <br />s rvAruRE OATL <br />CITY. ESS CENS-NO <br />PLUMBING IMEC <br />NI L <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />_T— <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />I <br />HEAT PUMi <br />I _ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />E1NK (SERVICE —BAR, ETC.) <br />i <br />lift <br />P <br />SUBTOTAL $ <br />-� <br />SUBTOTAL $ <br />I <br />PERMIT $ <br />41 <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECY NUMBER <br />FEE, <br />FED_,/ J� <br />REC�IPJ,NO <br />(,/JL <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES I] NO <br />FEES <br />FEE <br />BUILDING <br />PLUMBING <br />pa <br />G <br />TYPE OF CONN�SyTT <br />NO �II7N <br />NO, OF 5i ORIES <br />=UT`AIRy <br />GBGUt <br />No. Or MELLING UNITS <br />MECHANICAL <br />SIZE OF BLDG. <br />E SPRINKLERS REO'D <br />BASEMENT <br />❑ YES L) NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRER RM REO'D <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />4M <br />DATE 16C] <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />:oZ <br />r9 <br />