Laserfiche WebLink
the Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN INK— PLEASE PRINT <br />OWNER <br />CITY ZIP PHONE (^� ll--�A <br />AIL ADDRESS i^ I,A II%H\ 11 'i- rN nn I : ti `J - .J.�1 <br />ABCNNECTORDESIGNEB MAIL ADOTESS LILY ZIP PNONE <br />GENERAL CON TRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ApORESS CITY 21P PHONE LICENSE• <br />PLUMBINOCONTGACTOR AUR pDOnEss CITY ZIP PROVE LICENSE• <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ® ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSIOVEIFRPL. INSERT ❑ BUILDING RELOCATION <br />TENANT IMPBOVF.MENI ON INIENgp REMODEL ONLY � ,� • 10.TNIACI I`TRRVN MrU 1•I IONF Nn <br />p�Y _ <br />CONinACI PRICE OF WORK- I ".l. <br />-_______._______-_.. _-__ <br />DESCR E WORK ANDSOUABE IOOIAGE INVOLVED <br />PROi'OSEDu O,UILDING I HEREBYCRNFY MAT I IIAVE READ AND EXAMINED PHIS APPLICATION AND <br />__...._..._..__...___...-�....�..,.. ..,.....1-1 -, .,.,...,m,nuc IF I Awc AMC <br />Y' 1 lr'' <br />KNVYY :ITC Jnm. ,., oc mv�,,,.,,.,�..,,i..,...�i....,........., ... _...._...-- <br />ORDINANCES GOVERNING THIS 1YPE OF WORK WILL BE COMPLETED WITH <br />WHETHERSPECIMEO HEREIN OR NOT. THEGRANTING OFA PERMIT DOES NOT <br />ANY 01 HER 9TAI E OR LOGIVE CALTLAW REGULAY TO TING CONSTRUCTION OR CANCEL THE R THE P RONS F <br />FORMANCE OF CONSTRUC110N THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY 10 PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WIIII 111E STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAG L% ; <br />SIRIIniIUlT(11 CntOnnrII 1R,)r AHD(. nU)FD ARENT DATE t . <br />X - <br />APPLICANTS -CITY DV5111EASIirfnEr iiO AND BUSINESS NAME <br />LEGAL DEscBI%Tow or rnoPEmrlsHmYN eELowon Anncn roue co%Esl <br />q_ [' ( T <br />LO 7N GBLOCKy `� OF ?T Ei l Icl'`, 1`R' -� <br />PROJECT ADDRESS <br />I, / A <br />rx� C.�Jr) `(r1L� `7 .). I,-- I,� 111_ J 1. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />_ <br />A/C-A/HNDLGUNIIS_--H.P. <br />_ <br />BATHTUB <br />_ <br />_FORCED AIR SYSTEMS- RT.U. M EA <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />UNIT HEAL ERB- B.T.U. M <br />_ <br />SHOWER <br />_ <br />_ <br />CLOTHES DRYERS_ ____ <br />_ <br />KITCHEN SINK& DISP. <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />WATR HEATER <br />WOOD S10VE <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />_ <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />_ <br />_ <br />_ <br />_FIREPLACE INSERT _ _ <br />_- <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />_ <br />_ <br />GAS PIPING <br />ROOF DRAINS- RAINLEADRS <br />_ <br />EXHAUST FAN_ <br />SINK (SERVICE - BAR, ETC.) <br />_ _ <br />— <br />— <br />SUB 70TAL $ <br />SUB TOTAL S <br />PERMIT E <br />_ <br />_ <br />PERMIT E <br />TOTAL FEE E <br />-- <br />TOTAL FEE $ <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />I <br />PLANCN CKHUMITER <br />_ <br />FEE r-_ <br />RECEIPT NO. <br />USEZON <br />s <br />LOTAREA <br />of <br />vello ncn}II SITE <br />IT YES IC NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- 3UZ `'---- <br />r,�y) <br />- -- <br />��` <br />- <br />TYPE OF CONST. <br />ALIOWABIE/ACTUJ,`,Al <br />SIZE OF BLDG. <br />OCGUPANC <br />NO OF SIO IE9 BSMT. <br />_ R Y <br />VN - <br />NOOFDWIELLING UNITS <br />OL <br />OCC LOAD <br />-- -- <br />------- <br />PLUMBING <br />MECHANICAL <br />GRIER - - - - <br />-- -- <br />- <br />rInE SPRINKLERS nEOURED DYES HthO <br />IIETGIIt UMIIAtIDN <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPRBY <br />y� <br />L.-i <br />STATE ENERGY SURCIARGE <br />PUBLIC WORKS <br />TOTAL <br />