Laserfiche WebLink
'"a mv� <br />alit <br />APPLICATION FO:. <br />evereR <br />CITE°"°`"" <br />CONSTRUCTION <br />cm of <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />Xs IGN <br />MAIL ADDRESS CITY ZIP <br />PHONE <br />OWNERj /� ,/ <br />)Iq L! j,acob- <br />,���ii� yJ 1 <br />/45z � a4-tvu fT &PkLff31 G•!'r� WA <br />PHONE <br />ARCHITECT OR DESIGNER <br />Z <br />CITYMAIL ADDRESS <br />GENERAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP <br />�/0,K&AvOUa `risv� <br />PHONE <br />U2Z /Ya lY�tinlNP�f��� <br />LICENSE <br />c5f �4-� <br />JELL ........�- <br />MECHANICAL CONTRACTOR <br />MAII AOOPESS CITY E <br />PHONE <br />LICE SE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CRY ZIP <br />PHONE <br />LICENSE <br />^C�LASS OF WORK <br />❑ <br />❑ REPAIR ❑ DEMOLITION ❑ WOOOSTOVEIFRPL. INSERT 11 BUILDING RELOCATION <br />NEW ❑ ADDITION <br />ALTERATION <br />/`-� <br />VALOATION OF WORK IOOST OF MATERIALS PLUS LABORI <br />w <br />DESCRIBE WORK <br />J -Inl �P.Y ♦�./c /..A/ dl.�i 1. <br />S/�+..f7� <br />Y4GOf35 iN rKhfll!(l+F vpL-w.+ •s v.-•..... <br />,. __._— ,�. .. �. ___ _ -'- -- — <br />USEOFBUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATIONAND KNOWTHESAMETO BE TRUE ANDCORRECT. ALL <br />���adL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF PROPERTYISHOWN 3ELOW OR ATTACH FOURCOPIESI <br />LEGAL DESCRIPTION <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />LOT -BLOCK OF <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />�ibLL <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />�V�2L <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />51GNATURE OF C CTOR OR AUT ORIZED AGENT DATE <br />4 <br />APPLICANTS CITY BUSINESS ULENSE NO <br />PRO.IECTAODRESS, <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C - A/HNDLG UNITS - H P. <br />WATER CLOSET (TOILET) <br />REFRIGERATION UNITS - H P EA. <br />BATHTUB <br />BOILERS - B T.0 /H P <br />LAVATORY I WASH BASIN) <br />GAS FIRED ABC. UNITS- S T.U. <br />SHOWER <br />FORCED AIR SYSTEMS - B T U. M EA, <br />KITCHEN SINK A DISP <br />WALL HEATERS -B.T U. M <br />DISHWASHER <br />UNIT HEATERS -8. T. U. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />WATER HEATER <br />BACKFLOW PREVENTERS <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />SINK (SERVICE - BAR, ETC) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL <br />SUR':OTAL <br />T <br />PERMIT' <br />S <br />PERMIT <br />TOTALFEE <br />S <br />TOTAL FEE <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />FRONTSETBACN <br />REAR SETBACK SIDE <br />SETBACK <br />USEZOy@ p <br />y <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />/- <br />_I _ <br />DYES ONO <br />S <br />co <br />l! <br />BUILDING <br />`A' <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF SLOG <br />NO OF STORIES <br />MAX OC_' LOAD <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REQUIRED ❑ YES Cl NO <br />STATE ENERGY SURCHARGE <br />-PPLICATION ALC RV <br />PlAN5 C11ECNE:D/B <br />AAPPR FOR ISSUANCE BY <br />WORKS <br />/l <br />TOTAL <br />TOTAL <br />� <br />F mR nFTFRMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />