Laserfiche WebLink
LPPLICATION FOk. j YV/��°� <br />CITEwrpneR <br />CITY of CONSTRUCTION �-3-8'� <br />everett PERMIT evee. <br />retl <br />BUILDING DEPARTMENT 259.8745 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION $ZCOMBINATION ❑ BUILDING ❑ MECHANICAL ,PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS CITY ZIP PHONE <br />OR DESIGN ER <br />_MAIL ADDRE S <br />/ CITY <br />ZIP <br />Pnurvc <br />ARCHITECT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />GENERAL CONTRACTOR <br />i <br />�I <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />MECHANICAL CONTRACTOq <br />LICENSE A <br />CLLAASS OF WORK <br />.I R( NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />VALUATION OF WORK ICOST OF MATERULS PLUS LABORI <br />DESCRIBEWDRR- -n...-. /I 14,//. . / w'-4-7, , A /1 <br />USEOFSUILDI 1,JI / <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />oll ���I%DO�J //JiA,r,('i' <br />p <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW ORA ACP. OPIES) <br />OFWORKWILL BE COMPLETEDWITH WHETHER SPECIFIED HERE- <br />c. <br />LOTJ(/t—.BLOCK�OF <br />�— <br />- <br />IN OR NOT. THEGRANTING OFA PERMITDOES NOT PRESI,METO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OK <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />—" <br />OR THE PERFORMANCE OF CONSTRUCTION. , <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />PROJECTADDRESS <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />nn <br />qk <br />MECHANICAL <br />PLUMBING <br />NO. TYPE OF FIXTURE v <br />FILE <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSET JOILED <br />AIR COND. UNITS—H.P. EA <br />REFRIGERATION UNITS—H.P. EA. <br />BATHTUB <br />LAVATORY WASH BASIN) <br />BOILERS—H.P. EA. <br />it <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. _M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAIN S—RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE—SAR, ETC. <br />WOODSTOVEIFIREPLACE INSERT_ <br />SUBTOTAL <br />SUBTOTAL s <br />PERMIT s <br />PERMIT s <br />TOTALFEE s <br />TOTAL FEE s <br />THIS PORTION TO <br />BE COMPLETED <br />BY BUILDING <br />DEPT. PERSONNEL <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN CHECKFEEE <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />CONST. <br />APPLICATIO4 ACC <br />(PUNS <br />BUILDING <br />OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />I. FOR ISSUANCE BY <br />TOTAL <br />f <br />