Laserfiche WebLink
A(PPILIC,ntiON <br />FOR CONSTRIII.,CTION <br />PERMIT <br />the EvcrBreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />TO BE COMPLETED <br />IN INK — PLEASE PRINT <br />OWNER <br />MAIL ADDRESS <br />CITY ZIP PHONE <br />TENANT <br />MAILADDRESS <br />CITY ZIP PNONE <br />M j� ,fir <br />LiLass lzos S,E 6V _a*TfttL W Err 77/- S<yl o <br />IITECT POESIONER <br />I <br />MAIL ADDRESS <br />CITY ZIP PNONE <br />GENERAL CONTRACTOR <br />F. <br />MAIL ADDRESS <br />CITY ZIP PHONE LICENSE• <br />_ITcicl•-� tvcE�r.l r2. 60X �169 L.YNNWOaII 7YOy6 ii6.8$�.� 6�R-�/Idif1�_� <br />CHANICAL CONTRALTOfl MAIL ADORE59 CITY ZIP PHONE LICENSE• <br />I PLUMBING CONTRACTOR MAIL ADDRESS CITY Z:P PHONE 4CEN5[i <br />1 CtLASSOFWORK <br />Y NEW ❑ ADDITION Cl ALTERATION ❑ REPAIR ❑ ❑FMOI ITInN ❑ 71 .. <br />TENANiIMPROVEMENT OR TERIGR pEMDOEL ONLY <br />CqI ITRACi PRICE OF WORK 11390 <br />CONTACT PERSON ANO _PHONE NO, <br />DL 5 CRIBE WORK AND SOLAR FOOTAGE INVOLVED <br />INSracC Y7 ILLUAAIAIAM n U//I�� /GA! <br />PROPOSED USE OF RUILIpNh <br />UMAI C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO RE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOTTHEGRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH E PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTYTG FEHFORM THE WORK FOR WHICH APPLICATION IS MADC <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />288.20C WAC. <br />SIGNATUREOF ONTIACTORORAUTyH EDAGNENT <br />�PROJ[CT _No- <br />� <br />LEGAL DESCRIPJ ION OF PROPERTY ISHOWN PELOW OR ATTACH FOUR COPIES, <br />Lot BLOCK OF <br />ADDRESS <br />12 b S.E, L=UE2�cr MAz: y <br />AXPPLICAN/ CITY BUSINES <br />st <br />S/ s,DATE <br />LICENSE NO6 INESS NAME <br />Ca. c <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF ECUIPMENT <br />FEE <br />WATER CLOSET(TOIL ET) <br />A/C — A/HNDLG UNITS —H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MLA <br />_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. m <br />SHOWER <br />_ <br />CLOTHES DRYERS_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRYTR/.' <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URRIAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INS RT <br />FLOOR DRAIN <br />HEAT PUMP <br />_ <br />BACKFLOW PREVENTERS <br />_ <br />GAS PIPING <br />_ <br />ROOF DRAINS — RAINLFADERS <br />EXHAUSTFAN <br />SINK(SERVICE — BAR, ETC.) <br />SLB TOTAL $ <br />SUBTOTAL $ <br />_ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE $I <br />1,; NTSETBACK <br />REAP RPBACK <br />SIDE SETGACK <br />PLANCHECKNUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONEC <br />TYPE OF CONST. <br />ALLOWASLEJACTUAL <br />LOTAREA <br />OCCUPANCY GROUP <br />0YES s0E ONO <br />E9 <br />HOOF DWELLINOUNITS <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />— <br />PLUMBING <br />1 <br />SIZE OF BLDG.. <br />NO.OFSTORIES <br />BSMT. <br />D Y <br />ON <br />OCC LOAD <br />MECHANICAL <br />_ <br />HEIGHT LIMITATION <br />FIRESPRIHKLER9 PEOUIREp OYES DNO <br />APPLICATION ACC, By PUNS APPR.PY <br />OTHER <br />STATE BUILDING SURCHARGE <br />SW .ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />