Laserfiche WebLink
APPLICATIOA FOR CONSTRUCTeON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f 1 DEMOLITION 1 1 COMBINATION 1 1 BUILDING I MECHANICAL PLUMBING Fl SIGN <br />PROJECT ADDRESS _ <br />OWNER I MAIL ADDRESS CITY ' , nP PHONE <br />e)K <br />SL <br />TENANT <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />ARCHITECT <br />OR DESIGNER <br />MAILADDRESS <br />CITY ZIP <br />PHONE <br />GEN 11AL CON TR CTOR <br />MAILADDRESS <br />__ CITY ZIP <br />PHCNG <br />STATE LICENSE <br />�c <br />aoc� <br />/f%,�itlV_T�1R//`T'—Z�`i�r <br />o <br />y.ET�`f�rl irJ 3�a- <br />MECHANIC <br />L 0 I ACTO <br />MAIL ADDRESS <br />C TY ZIP <br />PHONE <br />STATE LICENSE I <br />�,�J�r'lt <br />FWMBING <br />CONTP6PTPR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WORK <br />HEATING SYSTEM: GAS F I ELECTRIC rl <br />DESC BE WORK ANO $O ARE OTAGE INV VED <br />/ <br />CONTACT PERSON AND PHONE O. <br />.T '�- <br />` <br />0 4 the <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRO', ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PROPOSED USE OF BUILDING <br />WORK ;,'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT DLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 I COMPLY WITH THE STATE <br />CONTRACTO AW 18 A 296.200 WAC. <br />X G <br />PARCEL TAX I.D. NUMBER / <br />CONSTRUCTION LO N LENDER, ADDRESS. TELEPHONE NUMBER <br />SIGNA IRE OATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO.1 <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—A/HNDLG UNITS — H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS — B.T.U.% M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERS — B.T.U. M <br />; <br />_ <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />' <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />' <br />DRINKING FOUNTAIN <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />; <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING r,' <br />EXHAUST FAN <br />' <br />D i <br />1 <br />I <br />I <br />1 <br />SUB TOTAL S <br />' <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />I <br />TOTAL FEE S <br />' <br />TOTAL FEE $ <br />' <br />�C ^Kie V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCI <br />FGE <br />RECEIPT NO. <br />VSITFR <br />JJ`` 77/ <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />RYES (1 NO <br />HEIGHT LIMITATION <br />NO OF DWELLING <br />SIZE OF BLDG/TI. <br />' <br />ON <br />PLUMBING <br />OCOUPANCY <br />NOOTSTORIES <br />OCCUPANTLOAD <br />BASEMENT <br />MECHANICAL <br />i <br />GROUP <br />' <br />❑YES F1 NO <br />ADDITIONAL PLAN CHECK <br />� <br />I <br />FIRE ALARM REO-p <br />REASON <br />I <br />OTHER <br />I <br />FIRE SPRINKLERPEO'D <br />PFASON <br />' <br />i <br />STATE BUILDING SURCHARGE <br />� <br />PUBLIC WORKS <br />i <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />' <br />DATE <br />