Laserfiche WebLink
APPLICATION FOR CONSTRUCTION <br />CITY OF EVERETT • BUILDING DIVISION <br />�113200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />rl 0 <br />EMOLITION4I1 COMBINATION BUILDING MIFCHANIral <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />PERMIT <br />OO;:7T <br />Il PI IIAAGIAIn n clr_u <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PIIONE STATE LICENSE <br />MAIL <br />PLUMBING CONTRACTOR <br />CITY <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: Cl GAS rl ELECTRIC n <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />6REV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />^LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />P.-.JVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 />X // QD- 9S <br />PROPOSED u E of a ILDING <br />S <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF_ <br />_ <br />PARCEL TAX 10 NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNAT RE DATE <br />CITY BUSINESS LICENSE N. <br />PLUMBING <br />MECHANICAL _ <br />NO. OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />_TYPE <br />A/C —A/HNOLG UNITS —H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />I <br />SHOWER <br />' <br />UNIT HEATERS — B.T.U. M <br />_ <br />' <br />KITCHEN SINK 8 DISP <br />; <br />CLOTHES DRYERS <br />; <br />DISHWASHER <br />I <br />VENTILATION FAN <br />I <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />0 i — <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />I <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />1 <br />I <br />I <br />I <br />1 <br />I <br />_ <br />SUBTOTAL $ <br />SUB TOTAL $ <br />; <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER'S <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />IIYES IT NO <br />BUILDING <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLOOM <br />1 <br />UNITS <br />PLUMBING <br />i <br />—r— <br />OCCUPNO OE SIORtES <br />OCCUPANT LOAD <br />BASEMENT <br />"' <br />GROUPANLY <br />MECHANICAL <br />30 I <br />f1YES TT NO <br />ADDITIONAL PLAN CHECK <br />i <br />i <br />1 <br />FIRE ALARM REO'D <br />REASON <br />OTHER <br />FIRE. SPRINKLER REGO <br />REASON <br />I <br />STATE BUILDING SURCHARGE <br />i <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />I —' <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />