Laserfiche WebLink
Q H Q <br />N <br />HZ <br />8e <br />ON <br />08 <br />y�V n <br />t' y <br />HH <br />gy M <br />n � y <br />HC/T <br />HOCA <br />APPLICATIIIII.N FOR CONSTRUC h 19ON PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />the Evergreen <br />CITY OF <br />everett <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC ❑ <br />_ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION <br />BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />OWNER MAIL ADDRESS <br />;3 Do,,/ S6/770C 8& <br />CITY <br />3Z25 Prn/E <br />ZIP PHONE <br />982o1-95-3G <br />= told <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE) <br />dCJ .d�/L <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAILADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />' Maw AnnITlnN ALTERATION ' : REPAIR :- DEMOLITION WOODSTOVE/FRPL INSERT -; BUILDING RELOCATION <br />e-�( <br />CONTRACT PRICE OF WORK 30� • �J <br />CONTACT PERSON ANO PHO/NE NO /�] <br />�4 `��G ^—✓ �� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />EcC/ 411Z <br />F <br />PROPOSED USE OF BUILDING <br />S �C/J� <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 WAG. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />' l'� L..' IC�1�� '!l_ _ <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />PROJECT ADDRES <br />^/�C <br />ICE V <br />S-�• <br />APPLICANTS OITYBUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING` Fr <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 />A/C —A HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORYIWASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />i <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />— <br />i <br />' <br />1 <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE $ <br />' <br />POP EIFFICF I IRF nNI Ve <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />OD • LSO <br />r 00 <br />TYPE OF CONTS. ALLOWMILE <br />TYPE OF CONST ACTUAL <br />a<uMltr <br />xo aownuxc uxlrs <br />cnwP <br />PLUMBING <br />SIZE OF BLDG. <br />NO, Of STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />:731- <br />OCCUPANCYLOAD FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />T_ <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PL SA PROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />