Laserfiche WebLink
"•PPLICATION FO(y �'Q everetl <br />she rwn <br />ci"OF CONSTRUCTION <br />clrr of <br />everett PERMIT <br />BUILDING DEPARTMENT 259.8810 TO BE COMPLETED IN INK • PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL AODRFL5 <br />ESS CUY ZIP PHONE <br />{CrNH�a Sloe �✓ >o �b3r A' /y"' YoY K <br />G AL CONTRACTOR <br />Ouyv"hTA.b061�iciymwood <br />MAIL ADDRESS <br />WTY <br />gvef�r4"�s�yc� <br />LIP <br />V (O. VI.ONE <br />�o%i6z-z/Z(-Ar)lefIiI <br />LIGLNSL• <br />l7p?-e,V <br />1 0 E <br />LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />LTV <br />2 P <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PIIONE <br />LICENSE <br />OF WORK <br />NEW ❑ ADDITION Cal ALT17RAT'ION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT Cl BUILDING RELOCATION <br />TIDN OF WORK (COST OF MATE RIALS PLUS LABOR) <br />/n/tlQ�D <br />IV FII <br />BE WORK <br />I r <br />USEaF qquILDINc <br />SY]Qt_ 1�70 Y� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATIONAND KNOWTHESAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORjINANCES GOVERNING THIS TYPE <br />OF WORK WILL BECOMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING 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 />xoe;) 9 *mr z z S 8 <br />LEGAL DESCRIPTION OF rROPERTYISHOWN BELOW ON ATTACH FOUR 9OPIESI <br />LOT- BLOCK OF <br />PROJECT ADDRESS <br />1 • ad- sa C-7- VP IV7f- <br />PLUMBING <br />APPLICANTS CITY BUSINESS LICENSE NO <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C - A/HNOLG UNITS - H.P. <br />BATHTUB <br />REFRIGERATION UNITS -H.P. EA. <br />LAVATORY (WASH BASIN) <br />SHOWER <br />BOILERS - B. T.0 Al P. <br />GAS FIRED A.C. UNIT - B.T.U. <br />KITCHEN SINK & DISP. <br />FORCED AIR SYSTEMS -B. T.0 M EA, <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />TRAY <br />UNIT HEATERS-B.T.U. M <br />LAUNDRY <br />CLOTHES WASHER <br />URINAL <br />EVAPORATIVE COOLERS <br />CLOTHESORYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />SACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS - RAINLEADERS <br />WOOD STOVE <br />SINK (SERVICE - BAR. ETC.I <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />_ <br />HEAT PUMP <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />__ <br />S <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT <br />i <br />TOTALFEE S <br />TOTALFEE <br />PLAN CHECK NUMBER <br />FEE <br />IS 4s <br />RECEIPT NO. <br />o6co8r <br />FRONT SETBACK <br />REAR SETBACK <br />510E SETBALK <br />IISE ZONE <br />LOT AREA <br />VACANT SITE <br />OYESXJNO <br />FEES <br />VALUATION <br />FEE <br />_ <br />BUILDING <br />g•� <br />_ <br />TYPED C(NST. <br />OCCUPANCY GROUP <br />0-7- <br />NO. OF DWELLING UNITS <br />'•69- <br />PLUMBING <br />SIZE O/F B'. DG <br />y _ Ck9J r <br />NO. OF STORIES <br />/ <br />_ <br />MAX OCC LOAD <br />-.5,25, <br />MECHANICAL <br />_ <br />OTHER <br />FIRE SPRINKLERS REQUIRED YES O NO <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS CHECNED BY APPR FOR ISSUAiiCE BY <br />&I <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />...moo <br />.,.etRl ;. FnR OFTFRMINING <br />ALL <br />PROPERTY UNE LOOATIONS AND RELATED EASEMENTS. <br />