Laserfiche WebLink
APPLICATIP�1 FOR CONSTRUCT�N PERMI'T ��� <br />TO BE COMPLETFD IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELEi TRIC O —j <br />�-- --- <br />25J 3F10 <br />�jti pEMOLITION C7 COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ MLUMBING ❑ SIGN <br />UN"IER MAILADDFESS CITY ZIP N1 PHONE ���Gr4(� �I. <br />s�Lo �u/�...,ce. tt.�%y1�s �/06 / il/E ? S�.laiT�zm 9di�te <br />TENANT MAIL AODRESS CITY ZIP PHONE <br />ARCHITECTO�ESiG���A�LA0DRE55 CITV 21P PHONE <br />f.GNFFGI f.ONT9lCTOfl MAILA�DRE55 CITV ZIP PHON? _ STATELICENSE� ` <br />MAIL <br />MAIL <br />^.ONTRACT PPICE OF WOHK <br />DES:R18= llOf. ; AND SOUAI <br />INVOLVED <br />PROPOSED USE OF BUILDING <br />LEGAL DE�SCRIPTION OF PPJPERTY �SNOWN BELOW J�R AT�T�/CH TV/O COPIES) <br />IOTJCl— BLQ'.K � OF J'?/l�IyC Fj(Q� <br />� /i-�79—.�00—l�z7��0� <br />PARCELTAXID.NUMF <br />_J--� <br />CONSii;CCTION LOAN <br />NO. TYPE OF <br />WATER CLOSET � <br />BATHTUB <br />LAVATORY(WASI <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />�� }! LAUNDRY TRAY <br />I ^LOTHES WASH <br />FLOOR <br />SINK <br />� L� �� � ����� <br />FDfTURE OR ITEM FEE <br />TOILET) <br />i BASIN) <br />DISP <br />FOUNTAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETI <br />LISE ZONE LOT AREA <br />TVPE Oi CON57. <br />SIZE OF BLUG. <br />OCCUPANCYLOPD <br />REASON <br />INTANE BY <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FIRE SPRINKtERS REO'D <br />FIRE ALARM REO'0 <br />onr[ <br />ov <br />21P <br />ZIP <br />PHONE <br />CONTACT PERSON `�D�P�HONE � I� <br />F ��lJ S <br />.�.�3-�0�0 <br />��� <br />STATE �ICENSE � <br />LICENSE � <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 COlAPLETED WITH WHETHER 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 />OWNER OF TFfIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />(:(1NTRACTORS LAW 1827 RCW AND 296200 WAC. <br />TYPE OF EOUIPMENT <br />AIC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTIIATION FAN __ <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN <br />< </ 7 O <br />VFCANT SITE FEES <br />rl vEs n No eui�o�N� <br />acuv.xcr xoaomu�xsuxns <br />teouo p�UMBING <br />BPSEMENT � MECHANICAL <br />❑ YES ❑ NO <br />lIEIGHi LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COOE IS 3105 TOTa� <br />SUB TOTAL $ <br />PERMIT 5 � <br />TOTALFEE S ' <br />RECEIPT NO. <br />VALUATION FEE <br />i <br />i <br />� <br />-----r- <br />_ ; <br />� <br />� <br />T <br />i <br />i <br />; <br />� <br />