Laserfiche WebLink
APPLICATIC-1 FOR CONSTRUCT' IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4Err <br />HEATING SYSTEM: I] GAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />CI DEMOLITION .COMBINATION LT: BUILDING J MECHANICAL ,PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHUNE <br />Trf we �sseuQ(�s ,to f toed pwfo EuR,d{ Wile c81os a5-5--51444 <br />TENANT MAIL ADDR SS A CITY ,r ZIP PHONE <br />pi E�,A" Pa Iyo';'$E E✓e+at� iaLtl Wo JS ctl Ui� 4 �� <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />✓F jLiL <br />CITY ZIIPP <br />PHONE <br />� <br />STATE LICENSE aY� <br />GENERAL HTRACTOR -/MAIL ADDRESS A \�� <br />y� I I�O }#:1� 1�G <br />�IJ �+1p <br />L <br />4CIIIlS V'�ir QLIi'.,O <br />, <br />r�r ?//?� <br />fL)ICDfJ* 1393K <br />M,ECHAM^ ,:ON MAIL ADDRESS SS <br />ZIP <br />PHONE <br />STATE L ENSE # <br />STATE LICENSEa <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />CONTRACTPRICEOF WORK <br />! J� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />V •< (� EL A_ _ aJ S y <br />We ({� 33---��d-5�4l <br />%rµaw"� •�,.u�i✓eucd-�rF.�i�S <br />m,.. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />GOVERNING THIS TYPE OF <br />PnsED SE OF BUILDING / <br />C • l� O (; C' <<!e'4 ►'�� <br />PROVISIONS OF LAWS AND ORDINANCES <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />L GAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />Lm BLOCK of <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�1 f <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />SD4GP/TiS� /1 �Ll <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 2E6.200 WAC. <br />_ <br />PARCELTAXI.D. NUMBER <br />,/ D � <br />�. 4 <br />81GNATLRE �A'° <br />- — <br />CITY NUSNEEE L CENSE NO <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRS <br />2 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE pF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNOLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <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 />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD Sl'OVE <br />�_ <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />; <br />URINAL <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />- <br />FLOOR DRAIN <br />1 <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />' <br />' <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />�_ <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />SUBTOTAL $ <br />' <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />' <br />PERMIT $ <br />-- <br />TOTALFEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFIL:t U5t <br />FRONT SETBACK <br />UNL.T: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHE KNUMBER FE <br />_ <br />7/_�� <br />RECEIPT NO. <br />/ <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ NO <br />FEES <br />VALUATION <br />FEE <br />�7 <br />// <br />t <br />El YES <br />BUILDING <br />%T/ <br />_ / <br />TYPE OF CONST. <br />NO. OF STORIES <br />OCCUPANCY <br />P <br />NO. GFOWFLLING UNITS <br />PLUMBING <br />n ' <br />L ' <br />13✓ <br />A% <br />MECHANICAL <br />1 <br />SIZE OF BLDG. <br />FIRE SPRINKLERS AEC <br />BASEMENT <br />Y l <br />❑ YES 'S? NO <br />; <br />T <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITATION <br />w <br />OTHER <br />REASON <br />STATE BUILD114G SURCHARGE <br />' <br />aver-&'Y' Wit, w1u5vu6,- _ <br />PUBLIC WORKS <br />IN TAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />ALOCAL <br />SALES <br />GATE 7, O : <br />�/i /� <br />TAX CODE IS 3105 <br />TOTAL <br />y <br />�1.. <br />