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 MAIL ADDRESS CITY ZIP PHONE <br />TENANT MAILADUHL55 CITY ZIP PHONE <br />ARCHITECT OR CESIGNER MAIL ADDRESS CITY ZIP PHONE <br />n4r^rec-ss,olI /)--,s,F.4J UA-c-KoAj nr rL7Ek'Fr7 qQl� CO <br />e <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR $1 DEMOLITION ❑ WOODSTOVF./FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR RE ODELONLY <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORKFOOTAGE VOLVPD <br />AND,�( <br />Pl %k Posl:O us of BUILDING <br />TIl1 <br />(OSOUARE <br />CONTACT PERSON AND PH NENOE' (�AJ -)7/_ <br />�' U '�q&S <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THEGRANTINGOFA PERMITDOESNOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE ONS OF <br />ANYOTHERS ATE OR LOCAL LAW REGULATING CONSTRUCTION OR TIHE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 1B.27 RCW AND <br />296.200 WAG J 0<7 <br />SIGNATURE OF CONTRACTOR ON AUTHORIZEDAGENT DATE <br />X/Cl/ � <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES( <br />ff <br />LOT ---(WO- of iU©ZL-L( �il �-�- S <br />U <br />— <br />PROJECTADDREss <br />1 <br />PLUMBING �O��y.. <br />APPLICANTS I YBUS LICTIIISNAME <br />ENO. AND BUSIN B� <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPEOFEOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/H NDLG UNITS — H.P. <br />.2 <br />BATHTUB <br />'� <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS— B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />_ <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS— RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />_ <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />— <br />PERMIT <br />$ <br />PERMIT S <br />TOTAL FEE <br />S <br />I <br />_ <br />TAL FEE S <br />f RONTSETBACK <br />REAR SETBACK <br />SIDE SE-3A K <br />57 <br />PLAN CHECK NUMBER <br />a a i q� <br />FEE <br />c <br />RECEIPT NO. <br />USEZONE /� <br />—Z_ <br />LOT AREA y- <br />7SXfsa� <br />VACANT SITE <br />❑YES )(NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />/- <br />I <br />TYPE OFCONST. <br />ALLOWABLUACTUAL <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BSMT <br />❑ Y <br />D N <br />OCC LOAD <br />MECHANICAL <br />OTHER <br />HRE SPRINKLERS REQUIRED ❑ VES ❑ NO <br />IIEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC. BY PLANS APPR. BY —1 <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />/�T <br />t� <br />—� <br />TOTAL <br />7 <br />