Laserfiche WebLink
1 �:�;,:. !'�,;�'.1 <br /> � APPLICAT11;r'�1 FOR CONSTRUCl'iON PERMIT <br /> � everett <br /> �� CITV O�reen <br /> ' �everett e <br /> ; <br /> ) BUILDING DEPARTMENT TO BE COMPLETED IN INK—PLEASE PRINT <br /> ; 259-8810 <br /> ; ❑ DEMOLITION ❑ COMBINATION Sd BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> � CITV ZIP PIIONE <br /> OKTlER MAILADDRESS <br /> i n �/J►tAH 1'EI Fr7tr ( U7.o �oF+iJ�+/ta E v�RET1' . 'Lr2-9off <br /> � TENANT MAILADDPE55 CIN 21P PHONE <br /> I AFCHITECTOAUESIdNEN MAILADORESS CITY ZIP PNONE <br /> �' <br /> CHfp <br /> QENERAICONTPACTOfl MAILADDRE55 CRV ZIP FlHONE LIGENSE� <br /> � /✓(aC/�A�t+ G.oE.s-r 2f3 t NIG�+��d Ac� E✓[�R�TT 98t,or �SL-�Yse NA'-/Sn�+1' z3ooH <br /> j MECHANICALCONTRACTOR MAIIADDflESS CITV ZIP PHONE LICENSEI <br /> ri <br /> � PLUMBINCaCONTMCTOR MAILADDRESS CITY ZIP PIANE LICENSEI <br /> :' <br /> ' ClASSOfWORK <br /> � ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ DEMOLITION I_7 WOODSTOVE/FRPL INSERT ❑ BUILDING REIOCATION <br /> � CONTACT PERSON PND PHONE NO. <br /> � TENANTIMPROVEMENTORINIEHIOPREMODELONLV <br /> i ¢ S 160 - <br /> CONTRACT PfiIC£OF WORK: <br /> � DESCRIBEWORKAN�SWAflEFOOTAGEINVOLVEO <br /> r NEl✓ l�''�` AI'F,�,F b� f9 <br /> 5r PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1 � �C S(OEr:r APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> l lE0AL0E5CFIPTIONOFPROPEPTV�SHOWNBEIOWORATfACHF�IURCOPIES�� H PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> f �ot �- 3 BIOCK 3 �S oF Evf .n' a�� N NOT. THE GRANT�NG OF A PERMIT DOES NOT PAESUME TO GIVE <br /> ' (� w AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � �'r ti 3 9ra 1-4 U�� 3b s EvE/L 7T D�✓� N OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF..ONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWN[R OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ; COhTRACTORS LAW 18.27 RCW AND 2962G0 WAC. <br /> SIGNRiUREOFCONTPAC70ROHAUTHORIZEOAGENT OATE Z S�lV <br /> � <br /> ' AT " ' /��WW^ <br /> � ,� � ��3 <br /> 1 PPOJECTADDqRESS <br /> I � (J� LO M R APPUCANTSCITYBl1SINE5SLICENSENO.ANDBU51NE55NAME <br /> � PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT FEE <br /> � WATEfl CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P. � <br /> �3 BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> i.j , UNIT HEATERS—B.T.U. M i <br /> UIVATORY(WASH BASIN) <br /> !; SHOWER ' CLOTHESDRYERS ' <br /> �i�� KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> '; i RANGE HOOD � <br /> i� DISHWASHER <br /> i I LAUNDRY TRAY � WATER HEATER ' <br /> '�� CLOTHES WASHER � WOOD STOV � _ <br /> URINAL ' METAL FIREPLACE 8 CH:MNEY ' _ <br /> i DRINKING FOUNTAIN � FIflEPLACE INSERT _� <br /> � HEAT PUMP ' <br /> } FLOOR DRAIN � <br /> 1 BACKFLOW PREVENTERS ; GAS PIPING _�_ <br /> ; ROOF DRAINS—RAINLEA�ERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> i <br /> � � <br /> .' � � <br /> � i � <br /> .� <br /> � � , <br /> �I�) SUB TOTAL $ i SUB TOTAL $ ' <br /> !i; PERMIT $ � PERMIT $ �_ <br /> �` TOTAL FEE $ ' TOTAL FEF $ ' <br /> !: <br /> ''� FRONTSETBACK REPRSETB�CK SIOESETBACK PLANCHECNNU�!EEfl FEE NECEIPTNO. <br /> usezoNe IOTAREA VACANTSITE FEES VALUATION FEE <br /> �' �; ❑ YES Q NO BUILDING . ' <br /> �� 1YPEOFCONSLALLOWABLE TYPEOftCNSf.RC1UAl oaVreNtY No.aDw[wNGUx�,u <br /> i <br /> ] �p�P PLUMBRdG i <br /> �T- <br /> SIZEOFBLDG. NO.OFSTORIES BRSEMENT MECHANICAI � <br /> � ❑,YE� ❑ NO � — <br /> � OCCUPANCYLOAD FIflESPRNKLEPSREO'0 N:JGHTLIMITAiION OiHER � <br /> � ❑ YES ❑ NO STATEBUILDItJGSURCHARGE f ' <br /> � <br /> ` qEA50NFOR5PRINNLEflS i <br /> � STATE ENEF7GY SURCHARGE � <br /> pPPLICATIONACC.BV PLANS�PPflOVEDBV CITYOfEVERETT PU�LICWORKS i <br /> LOCAL SALES ���� <br /> � TAX CODE IS 3105 TOTAL <br />