Laserfiche WebLink
I <br />the Evergwn APPLICATION FG Z evereH <br />CITY OF CONSTRUCTION <br />everett PERMIT e <br />BUILDING DEPT. TO BE COMPLETED IN BLACK INK — PLEASE PRINT <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />SILO Rill CEcy err D1pL_1,� <br />ARCHITECT OR DESIGNER MAILADORESS Cltt ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE -(� LICENSE• <br />T�,o.+ IN, ram._ J _ _ �.. O _ _ i �i: _ — I.. LFxy-S6v-2'a <br />ZIP <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PRONE LICENSE• <br />9 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL. INSERT ❑ BUILDING RELOCATION <br />VALUATIONOF WORK(COSTOF MATERIALS PLUS LABOR) <br />DESCRIBE WORK <br />1 lJSTry I -SIc cz, FZ / _ =1 <br />USE OF BUILDING <br />�+1_, l I L/Ll AJ_ <br />/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />KNOWTHE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN 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 O HORIZED AGENT DATE <br />X 9-;L � <br />LEGAL DESCRIPTION OF PROPERTYISHOWS BELOW OR ATTACHPLICATIONAND <br />FOUR COPIES) <br />PROJECTADDRESS <br />S T i,, Ll—Uj <br />APPLICAN rS Cl TyyUSINESS LICENSE NO. <br />So €�S 1' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS—H.P. EA. <br />13ATFITUB <br />REFRIGERATION UNITS—H.P. EA. <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />_ <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KITCHEN SINKS DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RPNGE HOOD <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />_ <br />STOVE <br />ROOF DRAINS— RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK SERVICE —BAR, ETC.) <br />WOCOSTOVE/FIREPLACE INSERT <br />— <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE $ <br />TOTALFEE $ <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER PLAN CHECK FEE <br />FEE RECEIPT NO. <br />USEZONE LOT AREA VACANT SITE '-- <br />OYES ONO FEES VALUATION FEE <br />TYPE OF CONST. OCCUPANCY GRCUP NO. OF DWELLING UNITS <br />BUILDING S� <br />SIZE OF BLDG. NO. OF STORIES MAX OCC. LOAD <br />PLUMBING <br />MECHANICAL <br />FIRE SPRINKLERS REQUIRED ❑YES ❑ NO <br />OTHER <br />APPLICATION ACC. BY PLANS CHECKED BY APPR. FOR ISSUANCE^BY PENALTY <br />\ '\ TOTAL 19 t0 ini,l <br />i <br />I <br />J <br />