Laserfiche WebLink
;-- - <br /> � <br /> 1 �,;, �, <br /> t !c:�;; , i') <br /> � � Q►PPLICATIOIiV FOR CONSTRUCTIbN PERMIY <br /> � fheEvergreen everett <br /> CITY OF � <br /> � everett <br /> 1 BUILDING DEPARTMENT <br /> � z5g_gg�p TO BE COMPLETED IN INK—PLEASE PRINT <br /> I ❑ DEMOLITION ❑ COMBINATION [_I BUILDING DQMECHANICAL ❑ PLUMBING ❑ SIGN <br /> � OWNEfl MAILADDRE55 CITV 21P PHONE <br /> � /y/� (�il�_, oA1N�rU,¢ /6/�/ .�nm/i� j��LfUf .2�? -9�/a9 <br /> � TENANT MAILADDRESS CITY ZIP PHONE <br /> a <br /> i <br /> ARCHIiECTORDE5IGNER M�ILADDPE55 CITY ZIP PHONE <br /> � CENERALCONTRACTOR M�ILADOPESu CITY ZIP PHONE LICENSE� <br /> ; �r�,�<�.��,a ,�l���i ��io �iz �,� �F- 9f��ti �sv- �:3st ,�a+k ti f3�1�� <br /> � MECNANICALCqJTRACTOq MAILAODflE55 CITY ZIP PHONE LICENSEI <br /> � PLUMOINGCONTflRCTOR MAILADDRESS CITY ZIP PNONE LIGENSEI <br /> ; 1�v5fwl.L�n4 ��-s w�a�(��� l-le.l4�lvP <br /> CUSS OF WORK <br /> : NEW ❑ ADDITION I I ALTEFATION I-1 REPAIR L1 DEMOUTION I_I WOODSTOVE/FRPLINS'cRT CI BUILDINGRELOCATION <br /> TENRNT IMPflOVEMENT Ofl INTERIOR REMODEL�Y. CONTACT PERSON AND PHONE NO. <br /> � CONiRACTPRICEOFWORN: Q <br /> 1 �ESCRIBE WOPK AND SOUAPE FOOTAGE iNVOLVEO <br /> iPfiOP SEDUSE (6UILOIN ' I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ! APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> J LEWLDESCRIPTIONOFPROPGFT'�SNOWN�ELOWORATfACH�Ol1RCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ' WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � �or OLOCK oF _ _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> j PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ! � OW�LR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ; APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> i CONTRACTORS LAW 1827 RCW AND 2g6.200 WAC. <br /> d SIGNATUflEOFCONTRACTORORAUTHORIZEDAGENT OATE <br /> 1 <br /> I <br /> � PRQIECT AUORESS �/ 0 % — � <br /> � / /� APPLIG NTS GITY BUSMESS LICENSE NO.A USMESS NAME <br /> 6 <br /> 1 PLUMBING MECHANICAL <br /> j NO. TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> i WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS--H.P. i <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M ' <br /> i <br /> i SHOWER � CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP � VENTILATION FAN ' <br /> I DISHWASHER � <br /> RANGEHOOD � <br /> ,I LAUNDRY TRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOOD STOV� ; <br /> ; URINAL � METAL FIREPLACE 8 CHIMNEY � <br /> i— <br /> ! DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> � FLOO:�DRAIN � HEAT PUMP i <br /> i — <br /> BACKFLOW PREVENTEAS ; GAS PIPING � <br /> � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN —T <br /> � <br /> ; SINK(SERVICE—BAR,ETC.) ' ~—� <br /> � , ' <br /> i � <br /> � � � <br /> � � i <br /> � <br /> i , <br /> S SUB TOTAL $ ; SUB TOTAL $ ' <br /> ' PERMIT $ � PERMIT $ / � <br /> �� TOTAL FEE $ ' TOTAL FEE $ � <br /> � FRONTSETBACK REARSETBAGN SIOESETBFCK PLANCHECKNUMBEfl fEE RECEIPTNO. <br /> � <br /> � USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ! <br /> O YES ❑ NO BUILDING . i <br /> ! TYPEOFLONST.PLLOWAOIE TYPFOFCONSLAC7VAL �u1'eNCY NoaoNRluNcuHrtS <br /> I GPWP 1 <br /> i PLUMBING ' <br /> —i— <br /> � SIZEOFt:OG. NO.OFSTORIES OASEMENT � <br /> � MECHANICAL 30 '� <br /> � ❑ YES CI NO , <br /> � OCCUPANCYLOAD FIRESPflNKLER5RE0'D HEIGHTIRAITATION OTIIER j <br /> � ❑ YES ❑ NO STATE BUILDING SUPCHARGE � <br /> j REASON FOR SPRINKLERS � <br /> � STATEENERGYSURCHARGE i <br /> APPLICATIONAGC.BY PUNSRPPROVEDBY CITYOFEVERETT PUDLICWORHS � <br /> ' LOCAL SALES �— <br /> ' TAX CODE IS 3105 TOTAL �� � � <br />