Laserfiche WebLink
APPLICATION FOR <br />CJNSTRUCTION <br />everett PERMIT <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ]COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />UWNIR MAIL ADDRESS ('ITY 71P PHONE <br />bict2 yin/ Xxmm vaoj / i'�i'rPi �%C/ - <br />ARCHLUCT OR DISIGNER MAIL. ADDRISS (IT) ZIP PHONE <br />G[MRAI CONtRA[i0R All ADDRI SS CITE ZIP PHONE LICENSE IF <br />s�� C,�Q7/(03 <br />MECHANICAL CONTRACTOR MAIL AUDIT SS (IIY ZIP MIONI IICENSEE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP P140NI LICENSE E <br />CLASS OF WORK <br />❑NEW ❑ADDITION ©ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK / <br />T 1/doro T i4 f-e se i ow 12t0 of o d ° <br />DESCRIBE WORK <br />PROPOSED USE OF RUILD NG <br />.e �ttt_ - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL HE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL DESCRIPTION Ur PROMPT PLOWN BuoW OR A71ACH FOUR COPIES) <br />LOT BIOCK�_OF E <br />l e 2c <br />IOR ADDRESS <br />/ H <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATT R CLOSE T(TOE I T) <br />AIR COND UNITS —HP EA <br />BATHTUB <br />REFRIGERATION UNITS -HP EA <br />LAVATORY MASH BASIN) <br />BOILERS-H P. EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP. <br />FORCE D AIR SI'STEMS-9.T U M EA <br />DISWASHER <br />WALL HIAIIRS-B T U M <br />LAUNDRY TRAY <br />UNIT If[ ATFRS-B T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CIOTHFS DRIERS <br />URINAL <br />VLNTIL A710N FAN <br />DRINKING FOUNTAIN <br />1 kANr • OOD <br />FLOOk DRAIN <br />AIR HAIW l'F'. UNIT- CF M <br />VACUUM BREAKERS <br />SIovF <br />ROOF DRAINS-RAINLI ADERS <br />MI. TAL I IRE PV."l. A CHIMNEY <br />SINK(SERVICE -BAR, TC) <br />SUB TOTAL <br />SUB TOTAL ! <br />PERMIT <br />! <br />r"P 17 ! <br />--- <br />- <br />TOTAL FEE <br />sl <br />I <br />I TOTAL FEE ! <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PL-N <br />FEE <br />CHECK FLE <br />RTC' ITT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />1]1'ES ONO <br />FEES <br />VALUA71ON <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />SIZE OF BLDG. <br />NO OF STORIES <br />MAX OCC LOAD <br />Pt UMBING <br />FIRE ZONE <br />BASEMENT <br />III GROOMS <br />FIRE SPRINKLERS <br />REQUIRED <br />OYES ONO <br />MECHANICAL <br />- <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />U.BC. <br />SEC. 30Xa) <br />2. BUILDING PLANS <br />TOTAL <br />Z,¢ <br />,nic <br />3. FIRE HYDRANT <br />4. FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN TROPE RLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />5 GR.ADINGA XCAVA7 ION A Cl E ARINGIGRUIIIIING <br />6 DRAINAGE <br />7 ENVIRONMENTAL IMPACT STATEMENT <br />B HEALTH DISTRICT <br />Ai'PLICATIONACC III I'1 ANS LHLIAI 11111 <br />APPEE <br />IORISSPA](. P. <br />