Laserfiche WebLink
APPLICATION FOR CONSTRUCTION PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Evergreen <br />CITY OF <br />everett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-6810 <br />= DEMOLITION � COMBINATION _ BUILDING � MECHANICAL �LUMBING SIGN <br />OWNER MAILADORESS CITY ZtP PHONE <br />�7�3�T w��-� ��,-A 3i8 Sc=. Ecii. �v1/ail wAY f�i. <br />�TENANT MAILFDORESS CIN 21 PHONE <br />Ofl DESIGNER <br />GENEflALCONTFACT9R MAILADDRESS GTY ZIP PHONE UCENSEs <br />MECHANICALCONTRACTOR MAILAODRESS CITY ZIP PHONE LICENSE� <br />F.UMBM CONTRACTOR <br />�/l �,r., S�-: I �t <br />CLA55 OF WORK <br />�_ NEW G ADDITION <br />CONTPFCT PRICE OF WORN <br />DESCRiBE WOfiN AND SOUARE FI <br />/z1dc� C l�✓� <br />PflOPOSED USE OF BUILDING <br />MMLADDRE55 CITY 21P PHONE LICENSEI <br />i/v.��r:�.� /%33i8 S �2 S-� ti'�� !4.-� i�To.� � , �3SSSSS /r1er�-sPt /c� iJ <br />�GLTERATION -� REPAIR !_: DEMOLITION ❑ WOODSTOVE/FRPL INSERT �� BUILDING RELOCATION <br />I CONTACT PERSGN AND PHONE NO. <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT OLOCN _. OF ._ .._. <br />PRQ,IECT AD�RESS <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />LAVATORY (WASH BASIN)� <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOf DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />USE ZONE <br />7VPEOFCONiS.ALLOWABIE <br />S2EOFBLDG. <br />JCCUPANCYLOAD <br />PEASON FOR $PR�NKLERS <br />INTPKE BY <br />TOTAL FEE 3 <br />LOTAREA I VACANTSITE <br />L3'd% <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T`/PE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NJT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS QF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIiORIZED (iY 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 296200 WAC. <br />SIGNATUREOFCONTRACTOqORAUTMORIZEDAGENT DATE `//q/p/ <br />J � � <br />X ,�'/�� � <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAAIE <br />NO. TYPE OF EQUIPMENT <br />A/�AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />— UNIT HEATERS--B.T.U. M ; <br />CLOTHES DRYERS <br />VENTILATION FAN <br />�rRANGEHOOD T— <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />BUIL�ING <br />TYPEOFCONST.ACTUAL OCCUGI.Ntr HO.Ofo�nllinGUxiiS <br />caouv p�UM81NG <br />NO.OFSTORIES BASEMENT MECHANICAL <br />FIRE SPRNKLERS REO'D HEIGHT LIlAITAiION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PLANSAPPROVED�Y CITY Of EVER8IT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />& CHIMNEY <br />SUB TOTAL 3 <br />PERMIT S <br />TOTAL FEE S <br />FEE I AECEIPTM1O. <br />� <br />� <br />� <br />