Laserfiche WebLink
[Tt Li1 � <br />�7 H3 <br />� qCA <br />HxH <br />< W <br />H 0 <br />Ux <br />HitH <br />*TJ <br />iA H <br />H_ <br />1O , <br />H t7 <br />HH <br />gU <br />C]CGr <br />t4 R3 dJ <br />H30CA <br />APPLICA'TIL A <br />FOR ICSli STRUCI SON <br />PERMIT <br />TO BE COMPLETED 114 INK —PLEASE <br />PRINT <br />Lj <br />the Evergreen <br />CITY OF <br />everett HEATINGSYSTEM: ❑GAS <br />Cl ELECTRIC ®���RivC�LF� <br />SA.S <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COCABINATION <br />❑ BUILDING <br />>GMECHANICAL <br />❑PLUMBING El SIGN <br />OWNER PxL RESS /�6 7- <br />re y .v,G(LI/M' <br />ZIP PHONE <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />�- <br />ARCHITECT OR DESIGNER MAILADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE/ <br />Mr,cd/ALCONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE j <br />C7/C/N,yOEF, fA� -.�% .zC/s—cL/• <br />�.9siyo /:D <br />96.%y4/ rE.c'Ti <br />3;-T.S r/ FP/ <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />LICENSE IF <br />CLASS OF WORK <br />! l NF-W fl ADDITION 5<ALTERATION ❑ <br />REPAIR ❑ DEMOLITION <br />❑ WOODSTOVE/FRPL <br />INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORN' <br />CONTACT PERSON AND PHONE NO. <br />e, ,eD <br />DESCRIBE WORK AND OUARE FOOTAGE INVOLVED <br />6, coo 7-.7 aw,5/t <br />_FADS <br />PROPOSED USE OF BUILDING <br />��—/L <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 THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED 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 CONSTRUCT!ON 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 />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />y,6 <br />PROJECT ADDRESS <br />APLUCMASCITY SUpfkEtSLI SE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER C'''.IET(TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN). <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />) <br />VENTILATION FAN <br />; <br />DISHWASHER <br />I <br />RANGE HOOD <br />I <br />LAUNDRYTRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />� <br />I <br />1 <br />SUB TOTAL <br />$ <br />SUB TOTAL 3 <br />PERMIT <br />$ <br />I <br />PERMIT $ <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />; <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USC ZONE <br />LOT AREA <br />VACA4T SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i <br />TYPE OF COINS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />o[Lv>.wcr <br />W g DMUING IM S <br />4P0i° <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCYLOAD FIRE SPRINKLERS REOD HEIGHTLIMITATION <br />OTHER <br />I <br />REASON FOR SPRINKLERS <br />'--'T <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANSAPPROVFJ BY <br />CITY Of EVERETT <br />PUBLIC WORKS <br />\ <br />LOCAL SALES <br />TAX CODE IS 3185 <br />TOTAL <br />