Laserfiche WebLink
APPLICATIQ~' FOR CONSTRUCT��N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: J GAS fJ ELECTRIC ❑ <br />259-8810 <br />LI DEMOLITION CI COMBINATION Il BUILDING j(�MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN�E% MFILADORLSS G7Y ZIP PHONE <br />TbuJ.}iZ.'� 7� r`�frr�f �7/3G �7€tilc- �Od .ty,�T' w' ISL- ZzzS' <br />TENANT MAIL�DDRE55 <br />CITY ZIP PHONE <br />ARCHITECT OR DESI3NEP MAIL qDDPESS LI7V 21P PMONF <br />GENERALCONTP4CTOR MAILADDRE55 G7V ZIP PMONE S7ATEUC.ENSE• <br />MECNRNICALCONTRRCTOR �/y_AIL�ADOPESS CITV ZIP PHONE STATEIICENSE♦ <br />�I�a1 //tRret�L ia?cio /�j/,F=.c � r.�8 .Elri 9A7di 3��3f� '� /�j'a9� <br />.UMBINGCON7RACTOR MAILADDRE55 CIiY 21P PHONE STATELICENSEN <br />CONTRACT PRICE OF WORK <br />�iif 1CS'ov <br />DESCRIBE WORK AND SLUAHE FOOTAGE INVOLVEO <br />PROPOSED USE OF BUILOING <br />SFk <br />LEGAL DESCRIPTION OF PROPERTV �SMOWN BELOW CR ATfpCH TWO COPIES� <br />LOT BLOGN OF <br />PARCELTAXI.O.NUMBER <br />CONSTRUCTION LOAN LEP <br />NO. <br />A��FE55. TELEPHONE NUMBER <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />1 <br />OR ITEM <br />SUB TOTAL $ ' <br />PERMIT $ , <br />TOTALFEE $ . <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PEARSEiBACK <br />USEZONE �OTqREA <br />iYPEOFCONSi. NO.OFSTORIES <br />52E OF BLDG. FIqE SPRiNKLERS REO'D <br />OCCUPANCY LOAD FIRE ALARM REOU <br />INTAKE BY I PLANS FPPFOVED BV <br />OATE <br />SI�E SETBACK <br />CONiACT PERSON AND PNONE NO. <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 TH�� iYPE OF <br />WORK WILL 8E COMPLETED WITH WHFTHER SPECIFIEO 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 CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L 1827 RCW AND 296.200 WAC. <br />�y ' ZZ-9 <br />SiGNalpp[ OAIE <br />LilY8U5ME55UCENSFe�n <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRl'ERS <br />V[NTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD <br />FIREPLqCE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />❑ YES ❑ NO BUILDING <br />OCLIIVANCY NO O4pWFlLINGUNIiS <br />GNOUV <br />PLUMBING <br />BaSEMENT MECHANICAL <br />❑ YES ❑ NO <br />NEIGHTLIMITATION ADDI710NALPLANCHECK <br />O7HER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />M E.A. <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />RECEIPT NO. <br />X <br />� <br />