Laserfiche WebLink
APPLICATION FOR CONSTR CTION <br />PERMIT <br />MB Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER MAILADDRESS CITY ZIP PHONE <br />RANT M r+ze� S t6 3L3— 539� <br />TENANT MAIL ADDRESS CIlV ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PLUMBING CONTRACTOR -T MAIL ADDRESS CITY ZIP PHONE LICENSE• <br />Eff NEW ❑ ADDITION Cl ALTERATION ❑ REPA'R ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONLY <br />CONTRACT PR ICE OFW FUIK ��000 <br />CONTACT PERSON AND PHONE NNO..y ^� <br />I�lu.)�%%L ro� 7Cf 7-7%/V <br />DESCRIBE WORK AND BOUARE FOOTAOEINV LVED <br />OOL/MEnLGOoNi <br />OPWEODING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHESAMETO 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 />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296.200 WAG <br />SIG TURE OF NTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF pROPERry 19HOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECTADDRESS��. <br />API ICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A(HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA Jp <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— &TU. M I� <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK DISP. <br />VENTILATION FAN <br />'• <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE $ CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />24/KLO rz�r POO L hglhX <br />SUB TOTAL <br />S <br />SUB TOTAL $ <br />PERMIT <br />S <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CH EC NBER <br />F7 <br />RECE,!y <br />C1J•'•/'SCFFEELE-ri <br />USE ZONE <br />LOT AREA <br />1iE 0 YES <br />YES p/1G0 <br />FEES <br />VALUATION <br />BUILDING <br />TYPE OF OONST. <br />ALLOWABLE/ACTUAL <br />OCCUPANCYGROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG.NO <br />OF 5TORIE9 <br />BSI.IT, <br />OCO LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED ❑ YES O <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. BY <br />zrcj <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />