Laserfiche WebLink
x C'z1 <br />rah <br />CC= <br />H <br />a�Tn <br />O x0 <br />Exj to H <br />Ea C <br />m O <br />0Hd <br />� MIS <br />G� • O <br />> A <br />L. z <br />H HB <br />gCO <br />H <br />C] C7 ti <br />Crl] <br />a H3 w <br />HOrA <br />c l <br />APPLICATIOPI .:OR CONSTRUCTIC ] PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC <br />ii <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />COMBINATION <br />✓BUILDING <br />MECHANICAL PLUMBING SIGN <br />OWNER <br />C1 <br />AtC <br />MAIL ADDRESS <br />L• ,v¢ha.c.L/ <br />CITY <br />Gvrot/T <br />ZIP <br />PHONE <br />MAIL ADDRESS <br />CNY <br />ZIP <br />PHONE <br />`TENANT // <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />C <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# <br />MECHANIGLCONRUICTOR MAIL ADDRESS CRY ZIP PHONE STATE LICENSE <br />MAIL ADDRESS <br />ZIP PHONE STATE LICENSE # <br />CLASS OF WORK <br />I— EW � ADDITION . ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT ! BUILDING RELOCATION <br />F 9 - <br />CONTRACT PRICE OF WORK 0-vv: <br />CONTACT PERSON AND PHONE NO. <br />DESCRIBE WORK AND SQUARE FOGTAGEJNVOLYED <br />PROPOSED USE OF BUILDING <br />.5 J=-­4 - <br />I HEREBY CERTIFY THAT 1 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 296.20 WAC. <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOWOR ATTACH FOUR COPIESI <br />UCT BLOCK OF <br />IRyaecT Aw)e^ ;,,-- -- -- <br />V��/ � �G � <br />site mAL o.re <br />Cnv BllSri[451C115F MJ <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 />BATHTUB <br />AC—AIHNDLG UNITS—H.P. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />_ <br />_ <br />_ <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 />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />T <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />; <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />A 4 <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />DOO <br />yr oc <br />TYPE Of DDNT$AIIOWABIE <br />TYPE OF COH5I ACTUAL <br />occurosr <br />AO IXDmumt urns <br />I <br />Gppp° <br />PLUMBING <br />� <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />I <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRINKLERS REO'D HEIGHT LIMITATION <br />SPRINKLER <br />I <br />REASON FOR SPRINKLERS <br />-- <br />�— <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PIANS PROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TOTAL <br />✓J� ;'f <br />TAX CODE IS3105 <br />✓ .` <br />