Laserfiche WebLink
APPLICATI" FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT _ HEATING SYSTEM: SfGAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION COMBINATION BUILDING ❑ MECHANICAL i PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />eo 4i: <br />ie_ TTa,v i,/� <br />&/ ivl�,2c,?'v <br />v <br />A✓� <br />c ✓d„ ' 982oq <br />353-9`f77 <br />TENANT <br />MAIL ADDRESS <br />CITY <br />fZIP <br />PHONE <br />ARCH17ECT OR DESIGNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IF <br />— <br />!T". L1'"�f„T! <br />p�l� PC'). 9,-...4 o9 <br />1-<2-1) n <br />Drl A1/0rir-amP <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <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 ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRA14TING 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 />O':'NER OF THIS PROPERTY TO PERFORM THE WE RK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RC W AND 296.200 WAC. <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES( <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT AD' DESS �J� . / <br />//� {/L// ��V y <br />S N IDRE DATE <br />LITY BUSINES. 'CENSEN <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 />A/C-A'HNDLG UNITS-H.P. <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />; <br />DISHWASHER <br />' <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC.) <br />_ <br />I <br />I <br />i <br />SUB TOTAL $ <br />; <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHE K y1BEfi <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILD114G <br />TYPE OF CONST, <br />NO. OF STORIES <br />occuvAxr <br />GROUP <br />NBOFBW1.114GIPUTS <br />PLUMBING <br />— <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />j <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />' <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />DATE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />' <br />