Laserfiche WebLink
the EYerymen '� A P P L I C,A► T I O N F:+ everen <br />CITY OF CONSTRUCTION <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259.8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ATMECHANICAL PLUMRING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />QoeAUli� r'�A1p(�r`*ut 14oZ S? . E Fie j T�i�Y �JCL°%ij}o4 <br />ARCHITECT OR OESIGN[R IAAIL AOCRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE s <br />MECHANICAL CONTHA..OR <br />CITY ZIP PHONE LICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRESS CC `Y CITY ZIP PHONE LICENSE• <br />C.. �...� CA.....•.. .A -c.I II�Tn<.1' TL Ud .>t tv-.< 1A'ilaI4 'WA -il.r., A I. aL <br />❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FR PL. INSERT ❑ BUILDING RELOCAT'ON <br />VALUATION OF WORK ICOST OF MATERIALS ELLS LABOR) <br />DES IBEWORK �-• C <br />\�FYIA.I A. i.�a i�.�ol.:• Mn�1 FxnnUSltA1 —c•C' �iR� 1..�i V1Q.0 ,\ ITF <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUROOPIES) <br />LOI_BLOCIC-OF <br />PROJECT ADDRESS <br />PLUMBING <br />APPLICANTS CITY BUSINE S' ICENSE NO. <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET( TOILET) <br />AIR COND. UNIT TS—H.P. EA. <br />BATHTUB <br />REFRIGERATIO14 UNITS—H.P. EA. <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. FA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />_ <br />KITCHEN SINK 5 DISP, <br />i— <br />i_ <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />_ <br />DISHWASHER <br />_ <br />WALL HEATERS—S.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />I EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOC <br />_ <br />FLOOR DRAIN <br />_ <br />00 <br />AIR HANDLING UNIT_ C.F.M. <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAI NLEADERS <br />METAL FIREPLACEA CHIMNEY <br />_ <br />_ <br />SINK (SERVICE —BAR, ETA_ <br />O • <br />OJ <br />WOODSTOVE/FIREPLACE INSERT <br />SUB TOTAL TOTAL <br />♦ <br />O <br />SUB TOTAL f <br />PERMIT <br />PERMIT f <br />1 ♦ <br />Ob <br />TOTAL FEE <br />TOTAL FEE <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL»IA���.sb <br />FRONT SETBACK IREAR SETBACK <br />(VACANT SITE <br />DYES ONO I <br />NO OF DWELLING UNITS <br />BY I APPR. FOR ISSUANCE BY <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />TOTAL <br />FEE IRECEIPT NO. <br />VALUATION I FEE <br />