Laserfiche WebLink
APPLICATION FOR CONSTRUCTI.ON PERMIO*ff <br />TO BE Cu.APLETED IN BLACK INK —PLEASE PRIM 1 <br />L HEATING SYSTEM _ (GAS <br />:J ELECTRIC <br />IJ <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLITION COMBINATION <br />1KBUILDING <br />IIi1GECHANICAL <br />ILPPLUMBING I I SIGN <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP <br />r11IONE <br />u c, <br />.'l 0 % 1 % <br />-j c :w,,...; y <br />:,Ir S� N IT LA.,U <br />O di <br />wl? . '7 •:,;; :, , :� ; ., <br />TLNANT L ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STAFF LICENSE <br />(�R1�/-�-Sct''lUc�r�(JD'✓_'= <br />MECHA (CAI CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />—� STATE LL'ENSEa p <br />PLUMBING CONTRACTOR MML ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE II <br />�1,.. 1v._ �J>._-.TL..___ ASaJ.rr- /, c....r �.(✓ _ ___.IC•J_' <br />,9i,:=: <br />o... , /. - SFu.:,�. '-•'o /AnnA <br />CGNTRACI PRICE OF WORK <br />OF SCRIBE WORK AND E iUARE IF DOTAGE INVOLVED <br />CONTACTFIIERSON 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 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 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 />/J <br />z � 1 C- �xu�✓[' � 9- � 5 <br />S.CNAIURE �' DAIL <br />PROPOSLDUSE OF BUILDING <br />p <br />S '� ^- I" <br />LEGAL DESCRIPT ON OF PROPERTY (SHOWN BE OWOR ATTACH TV4OCOPIESI <br />�_ 11j U(/(, �1 G cwvL <br />LOT BLOCK of ---r <br />---- _ <br />W <br />PARCEL TAXI D (LUMBER <br />CONSTRUCTION LOAN LENDER. ADORES S. TELEPHONE NJMBEH <br />PROJECTADDR SS <br />car BUSIN ,S 1.11 W4 NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />ABC—A4iNDLG UNITS—H.P <br />BATHTUB <br />J <br />FORCED A.9 S'STEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS--B.T.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />_ <br />1 <br />DISHWASHER <br />1 <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />J <br />CLOTHES WASHER <br />--� <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />o2 <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />_ <br />SUB TOTAL .` <br />SUB TOTAL 5 <br />PERMIT S <br />— —� <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE 5 <br />' <br />Cf%ri nCPICC 1IRF nNl V• i <br />FRONT SETBACK / <br />REAR SETBACK <br />/ <br />SIDES K / <br />PLAN CHICgrLIDER <br />FEE �� <br />RECE17Y <br />I <br />7 <br />) <br />lam{/ <br />USE ZONE <br />LOT nREn <br />W ANTSITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />e <br />YES .. NO <br />TYPE OF CBLSI <br />NO OF STORIES <br />IXcu°+u-r <br />ro1 U DAuu,u u'd6 <br />PLUMBING <br />_ <br />/ i <br />SIZE OF BLDG <br />v� <br />Ell,[ SPRINKLERS REO'D <br />BASEMENT <br />- <br />MECHANICAL <br />17331 <br />YES !E NO <br />ADDITIONAL PLAN CHECK <br />/J <br />n i73 <br />OCCUPANC'. LOAD� <br />FIRE ALARM REOD <br />HEIGHT LINIITATIDN / <br />OTHER &Llo <br />IM ✓J <br />REASON <br />STATE BUILDING SURCHARGE <br />I�L. <br />PUBLIC WORKS <br />/ ' — <br />INTAKE BY PLANS APPR VED BY CITY OF EVERETT <br />LOCAL SALES <br />nAIF TAX CODE IS 3105 <br />TOTAL <br />��7 Q <br />7 / 7 i / - <br />E, /i 9S <br />I <br />