Laserfiche WebLink
APPLICATIC ; FOR CONSTRUCTPIN PERMIT <br />TO BE COMPLETED !N BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: '❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />L 1 DEMOLITION I COMBINATION XBUILDING I I MECHANICAL CI PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />�i(%i4C1/iA'V7 <br />TENANT MAIL ADDRESS CITY ZIP PMO E <br />F'dREST /�i0.c'.E S'AA �a;PI.Y <i��2 FOEAPi�C �YrF EI/iF.PETT /v/><. _ <br />ARCHITECT OR DESIGNER MAIL ADDRESS T CITY ZIP PHONE <br />TEAeay /AE75;rx BQ A1,4 )9,P7. oif 7 /_/zOW& 41F <br />GENERAL CDNTRACTOR MAIL ADDRESS I, TY ZIP PRONE STATE LICENSE N <br />MECHANtkL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE 0 <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />CONTRACT PRICE OF WORN V O v <br />DESCRIBE WORK AN SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />FA <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDINe) <br />�( "✓',(E/,NI ,�1 <br />U� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN E ELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK .. <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAX I . NUMBER <br />�� .. mil► 3�//s' <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS / <br />/3c) .(� <br />SIGNATURE 11 DATE <br />CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />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 E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.TU. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />c <br />VENTILATION FAN <br />i <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <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, <br />I <br />' <br />SUB TOTAL $ <br />' <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />I <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHEq NUMBER <br />ysg <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES/P_ <br />BUILDING <br />TYPE OF CONST. <br />NO. OF STORIES <br />OCCUPANCY <br />GROUP <br />NO Or DWELLING UN17S <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'O <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REQ'D <br />HEIGHTMITATION <br />LI <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />