Laserfiche WebLink
, , ,..� <br />A�PLICATaOr� FOR CONSTRUCT�JN PERMIi <br />fne Evergreen <br />cin oF <br />everf�tt <br />Bl ..DING OEPARTMENT <br />25.: 8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />-I DEMOUTION _ COMBINATION BUILDING MECHANICAL ' PLUMBING <br />OWNER MAILADORESS � CIiV ZIP PHONE <br />MAI: ADORESS <br />CIiY ZIP ' PHONE <br />everett <br />e <br />:'� SIGN <br />ARCHRECTORDESIGNER MAILAOOFESS CITY ZIP PMONE <br />soc,o,b„n - t,�rrH, A2c►+,�s i3r � N.E. QA�r,v�� ewd, s"�fihr�. c.u� S�s- sc� o <br />GENERALCONTRACTOR MAILADOFESS CITY ZIP HONE CGENSEu <br />k%ccr So+.wa Cz�u;772. TNc. %r). gox i(olS F��F�-:� .td1}� �"jA2o3 'a� 3- 3552 <br />MECHANICALCONTRACTOR MAILA��RE55 CITV ZIP PHONE LICENSEp <br />'� W E,1`-(SG Z i l( <br />PLUNBING CONTRRCTOR MAIL ADOPESS CITV 21P PHONE LICENSE N <br />l� <br />CLASS OF WORK .{� <br />x NEW Cl ADDITION �µ ALTERATION G' REPAIR ❑ DEMOLITION �-.! WOODSTOVE/FFiPL IMSERT ❑ BUILDING`RELOCATION <br />TENFNTIMPqOVEMENTOflINTERIOqREMODELONLV CONTACTPERSONANDPHONENO. 9 $� y S <br />CONTRACTPFICEOFWORN: �f 4/p avo . ...)�Et, R�F�26S�tC�L- 337-07Z7 <br />DESCAIBE WOFN AND SOU�RE FppTAGE INVOL`� D <br />�- ��ia„ 4S eF wc_._. Qe.iS7]P.. <br />oF aui�owc <br />LEGAI DESCRIPTION OF PROPERTY �SHOWN BELOW OR ATTFCH FOUP COPIES� <br />LOT�_ BLOCN �D )N OF ���v�Z <br />NO. <br />WATER CLOSET <br />BATHTUB <br />LAVATORYIWAS <br />8 <br />URINA!. <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTEFiS <br />FRONTSETBrCK Y <br />2 � 'J <br />US€ZI NE <br />� <br />TYPE Of CONST. ALLOWABLE <br />SIZE OF BLDG <br />S, yli.'l5 <br />OCCUPAHCVl0A0 <br />REASON FOp SPRINNLERS <br />APPLICATION ALC. BY <br />PERMIT $ <br />TOTAL FEE $ <br />REARSETBACK DINC!OESETBACK <br />i. 1_. . � r l _ 4 <br />LOTAREA <br />/�o4q <br />TVPE OF GONST. ACiIIA_ <br />NO.OF STORIES <br />� <br />FIRE SPRNKLERS REO'[t <br />f_7 YES 'iC NO <br />�OVEO BY <br />ii <br />� ,; <br />S �- <br />VACANT SITE <br />`1( YES ❑ NO <br />OCCOGANCI hOGiONELliNG01lIt5 <br />GPppP � <br />BASElAENT <br />2C YES �.-:1 NO <br />NEIGHT Uh11TATION <br />/7_ I 4 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINA!��;ES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH V:HETHER SPECIFIED HEREIN OR <br />'•NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OW�ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATOREOFCONTflACTOflORAUTHORi2E0AGENT DATE <br />�� <br />n-N <br />BUSINESS <br />TYPE OF E�UIPMENT <br />NDLG UNITS—H.P. % /S'; <br />AIR SYSTEMS—B.T.U. M <br />1TERS—B.T.U. M <br />VE�TILATION FAN __ <br />RA��GE HOOD <br />WA'i ER HEATER <br />WC�OD STOVE <br />METAL FIREPLACE 8 CFiIMNEY <br />FIREPLACEINSEAT <br />,t�E <br />�l9 <br />` VALUATION <br />o> So.3y3 <br />,� �_�_ <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SUF?CHARGE <br />STATEENERGYSURCHAFGE <br />PUBLIC WORKS <br />TOTAL <br />NAh1E <br />i <br />FEE <br />sG ; � <br />� <br />—T <br />� <br />� <br />� <br />—�-- <br />(J � o0 <br />� <br />� <br />T <br />! 1 <br />/V <br />Yr� <br />.� , -� <br />� [ / <br />E <br />T <br />��8 <br />i <br />Qi d0 <br />YU ; e`3 <br />