Laserfiche WebLink
AF'PLICATIG.J �OR CONS7Rl1C i�W JFI P�RMIT ��«P« <br />T BI' 7pL 'ED IN INK PLEASE PRINT <br />t;aEvergrcan � C'�� E� — � <br />GT1' OF <br />eve rett HEATING SYSTEM: U GAS ❑ ELECTRIC i,_I ___ _� <br />6UILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION AUILDING MECHANICAL PLUMBING XSIG�! <br />OWNER IfAILAODfiE55 GIiY ZIP PHpN[ <br />_NAPA �R1S 1-;4�c++wE S'Hno 9i10 Ev62c�me� wA. Ev6�, ?� 2^ 3/yl <br />i[NANT MAI.ApDR[SS CITY ZIP PHONE <br />S AM t' -- <br />�RCNRFCTOROESIGNER IAAILA�DRESS GTY ZIP PNONE <br />MAIL <br />v�^-��� i�tvrv irv�. � r� <br />ldECHAKICALCONTMGTOR MFILAD�RESS <br />cirv z r <br />vNuadp g$� <br />crtv nr <br />PHONE LICENSE a <br />PLUMpINGLONTfiAGTOR Mf�IL�DDRESS CITV ZIP PMONE <br />Q 1^5 OF Y �0.1K <br />�.NEW i�. ADDITION .� ALTERATION �'. REPAIR �. DEMOLITION � WOODSTOVE/FRPL INSERT <br />/� CUNTAC/T�PERSON AN� P40NE /f!0� � � <br />GONTRACT PRICE OF WOR ��L% 3�, � ��/ RN M♦ �./}��� / <br />DESCRIOE WOPH AND SOU4RE FOOTAGE UlVOWE� <br />lNStM� Cuc,nw,C»s ��i) SI< /�uu��w�iirv G/AtL SiGn�S <br />PROPOSED USE OF BU�LDING . <br />COMMl52G1/YL /%JG6'i.,�'Ic{ � .�,1'.(�It-"� <br />✓ <br />LEGAL DESCRIPTION OF PROPERTV �SRpW N �ELOY! OR ATTpCH FOUR COPIESI <br />LOT____ BLOCK OF _ <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />FOR QFFICE USE ONLY: <br />FPONTSETBFCN PEnR SET�ACK <br />USEIONE ���En <br />�' r 13� <br />fYPE OF CONIS. ALLCWABLE iYVF Oi CCSS� A( <br />SIZE OF BLDG. <br />OGGUR'NCYLOAD <br />SPPINNI.FFS <br />i�n�.m�, [�v <br />FEE <br />i , <br />� <br />SUB TOTAL ,o I <br />P[RMIT S <br />TOTAL FEE $ <br />SI�E SETBACK <br />VACANT SITE <br />NOAF STOFIE$ <br />FIRE SPRNKIEFS PEO'D <br />FLANS APPROVED BY <br />occu�u�cr xoa-o�n�¢�ur;cw.��s <br />eaouc / <br />GASEMENT <br />LIRt1TAT10N <br />CITY OF EVERET� <br />LOCALSALES <br />TAX CODE IS 3105 <br />LICENSE s <br />LICENSE M <br />. BUILDING RELOCATION <br />�.Aez�— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE- TaUE AND CORRECT. ALL <br />PROVISIONS OF LAVr'S AND ORDINANCES GOVERNING THIS TYPE Of <br />WORK b711L hE COMFLETED WITH WHETHER SPECIFIED HEREIN OR <br />NnT. TNE GriAN'ING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TH6 PROVISIONS GF ANY <br />OTHER STATE ('iR LOCAL LAW REGULATING CONS-fRUCTION OR THE <br />P[RFORMANCc Of CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF iHIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br />CONTRACfORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUiIEOFCONTRACTORORAUiHOP�IZEOAGF.NT �ATE <br />X 1 /ai,. �� � X /��23�4 2 <br />FPPLICAN SCiL�SUSLLYFSSLICENScN .ANDEl1S�NE $NAM1I <br />NO. TYPE OF EOUIPMEN? FEE <br />A/C—A/HNDLG UNITS—H.P, <br />FORCED AIR S`.'STEMS—B.T.U. M17 F.A. <br />UNIT HEATEflS—B: f.U. M <br />CLOTHES DRYERS � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE � <br />METAL FIREPLACE & CHIMNEY <br />FIREPlACE INSERT � <br />� <br />HEATPUMP � <br />GAS PIPING <br />EXHAUSTFAN � <br />DUILDING <br />PLUMBING <br />MECHANICAL <br />ADOITIONAL PLAN CHECK <br />OTHEfl <br />STATE BUILDING SURCHAHGE <br />PUBLIC WOFKS <br />rora� <br />SUB TOTAL � <br />PEFMIT 5 <br />TOTAL FEE S <br />/�� REGE/IP,iNO <br />� %4 �� <br />� <br />� <br />� <br />� <br />r <br />�b�� <br />