Laserfiche WebLink
I <br />APPLICATItN FOR CONSTRIJC`�ON HERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />!AB EvBlgTcen <br />CITY OF <br />everett HEATING SYSTEM' GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING (MECHANICAL PLUMBING SIGN <br />Y1 �.� <br />CITY PHONE <br />OWNER MAIL ADDRESS ZIP�4� —EO / 7�O <br />24j7 1,AP-LIN GYZ �/E��TT [� <br />m�j <br />LA1 <br />AD�zl <br />13 xH <br />C H <br />� <br />L CD <br />O=0 <br />CAI H <br />H [^ <br />L7 0 <br />OHb <br />> Ht7 <br />rHH <br />g� <br />CD t7 cn <br />2 H In <br />-3 O CO <br />V/1 Suase <br />ZIP <br />PHONE <br />TENANT <br />MAIL AODRE55 <br />CI <br />Z=!w <br />MCHRECT OR DESIGNER <br />MAIL ADDRESS <br />CIT+ <br />ZIP <br />PHONE <br />ZIP <br />PHONF <br />LICENSE III <br />GENERAL CONTMCTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PI AE <br />LICENSE I <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />OW N I%Iz <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />Zlp <br />rece nr wnRv <br />- <br />..... .....�,.. <br />onu nlu2 GFI IICATI(1N <br />ADDITION ALTERATION <br />REPAIR <br />DEMOLITION WOODSTOV� <br />CONTACT PERSON AND PHONE NO. <br />r <br />CONTRACT PRICE OF WORK / <br />'/ <br />DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED q nW {�, <br />E E1_EGT Ic Z- w GAs <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />I <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />SI NG LC FM1� I L PWE-' L I Nei <br />APPLICATION <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTYISHOVMB 'ORATTACH FCURCOPIESI <br />NOT. THE GRANTING 0° A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />AUTHORITY f0 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 />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 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZEDAGENT DATE <br />l <br />PROJECTADDRESS <br />L�(�LIN D EU�2ETT <br />�32o� <br />APPLICANTS <br />CITY BUSINESS ULINS DAND BUSMESSNAAIE <br />2 <br />MECHANICAL <br />PLUMBING <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—A/HNDLG UNITS—H.P. <br />/ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />— <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />I <br />RANGE HOOD <br />DISHWASHER <br />/ <br />WAT =R HEATER <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />SINK (SERVICE —BAP, ETC.) <br />T� <br />SUB TOTAL $ <br />SUB TOTAL $ <br />3 �� <br />PERMIT $ <br />PERMIT $ <br />�1 <br />Y <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE <br />FRONT SETBACK <br />ONLY: <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />RECEIPTNO <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I MEOFCONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />CC`uVAVCV <br />xB IXOWTLLInBUxns <br />PLUMBING <br />MECHANICAL <br />yr <br />$¢E OF BLDf.. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />HEASON FOR SPRINKLERS <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BV <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />yS <br />