Laserfiche WebLink
Du�lEl,��� o�' � L' �%. <br />�'� � APi�LICAT`JI�I FO1� CONSTRIJC r IOId PERIIAIT <br />rhoE�a�r��can TO BE COMPLETED IPl INK—PI.CASE PRINT <br />CITY OF <br />�Vere�� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />�UILDING DEPARTMENT <br />259-8810 <br />C', DEMOLITION ❑ COMBINATION ❑ BUILDING Ci MECHANICAL i` LUMBING <br />OWNE�%i!/iJ /i)/1�JILA��L��nnA//I�}� �i GITV' ���'�J��l �/J�. .PHCE7f/�-lCi_ <br />M ' A�DRESS <br />MAIL AODRESS <br />IAFIL AD01.'.: SS <br />L <br />CITV <br />CITY <br />CITV <br />CITY <br />(lr_'1� SPCL <br />CITY <br />21P <br />zir <br />ZIP <br />ZIP <br />Y11 <br />ZIP <br />PHONE <br />PHONE <br />PHON[ <br />LICENSE N <br />IICEN$E q <br />��r- <br />LICENSt tl <br />everetf <br />e <br />CLA55OF 1YORK <br />I I NEW ❑ ADDITION D ALTERATION I_l REPAIR I_J DEMOLITION Ll WOODSTOVE/FRPLINSERT ❑ BUILDWGRELOCATION <br />��/� I CONTACT PERSON AND PHONE NO. <br />DESCRIOE WOFK A�lO SOUARE FOOTAGE INVOLVE� <br />PROPOSED USE OF BLIILDING I v e <br />(/.11�-e-O S"�sc0 <br />LEGhL OESCPIPTION OF PqOPERTY �SHOWN BELOW OR ATfACH^ FOUR COPI/ES� <br />, LOT BLOCK __ OF ��K(' �-C�J — <br />PROJEC�A�DRESS �� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />� LAVATORY(WASH BASIN)� <br />SHOWER <br />hITCHEN SINK 8 DISP <br />DISHWASHER <br />_� LAHNDfii`fiRAY � <br />CLOTHES WASHERT 'n � <br />URiNAL <br />nRINKIN i FOUNTAIN <br />FLOOR DRAIN <br />BACKFL�W PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FEE <br />SUBTOTAL 5 /S- i <br />PERMIT $ — o <br />TOTAL FEE $ o�t ; <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK RE�RSETBACN <br />USE ZONE LOT AREA <br />iY�E0�C01175.ALL04YABLF iY{'EOFCOIIS7.AGiI1FL <br />SIZE OF �LOG. NO.OF STORIES <br />OCCUPANCYLOAD FlFiESPFNNLERSR[( <br />�EASON f0(1 SPlIINNI.C�S <br />INTANEEY PLANSAPPflOVE��Y <br />51DE SETAACK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPL�CATION 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 GRANTIN6 OF A PERMIT DOES NOT PRESUME'i0 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUTATING 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 AN� I COPdPLY WITH THE STATE <br />CONTflACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATUREOF RACTOROflAUTHORIZEDAGENT OATE <br />X � � <br />� � <br />APP�I 5 CITY�U&1 SS LICENSE 1lO. AND BUSINESS NAA1E <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />—�— <br />UNIT IIEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING ' <br />EXHAUSTFAN � <br />— �— <br />PLANCHECKNUMBER I FEE <br />�UILDIN3 <br />acup�ucr noa�o��vnuxcunrts <br />�POpP PLUMBING <br />onSEMENi MEC 'ANICAL <br />HEIGHT LIIAITAT101! ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOC�iL SALES <br />TAX CO�E IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />np <br />n <br />�p <br />N <br />@y <br />N <br />