Laserfiche WebLink
APPLICATIC Y FOR CONSTRUCT 3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />IltAHNLs bYb I EM: J GAS <br />❑ ELECTRIC .J <br />1 <br />259-8810 <br />— <br />❑ DEMOLITION [iWCOMBINATION <br />❑ BUILDING <br />❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />OWNER /��/` MAILADDRESS <br />r" ~ p" %�9 �/ PE L jy <br />CIN <br />hoRG/w <br />ZIP PHONE <br />TENANT 1 <br />/ go <br />ego �/�/L�'� <br />p �T p <br />3 �L1 y / o <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />—� <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />�RAL <br />CITY <br />ZIP PHONE <br />LorSi. '21 /llr fif„/a //L� <br />GENERAL CONTRACTOR <br />CONTRACTOR <br />EY<•�i_I�7'T <br />ZSI- <br />MAIL ADDRESS <br />ADDRESS <br />CITY � <br />ZIP PHDNE <br />STATE LICENSE I <br />PHONE STATE LICENSE I <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP <br />�/�/I�/ PHONE STATE LICENSE I <br />0AFri V/I.. <br />— <br />CONTRACT PRICE OF WORK <br />'7 1- T- `/ -6 O <br />DESC/RrIBE WORK AND SOUARE FOOTAGE INVOLVED <br />�I1O/ r/JN-f f%r-If PFc <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />/1F. Cr'- <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />NANCES <br />LAWS AND ORTHIS TYPE OF <br />GOVERNIN <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW C R ATTACH TWO <br />$ <br />COPIES) <br />WORKSWILLS EFCOMPLETED WITIH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK OF-d <br />it/LLB <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />✓ s <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />Lu <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 PF'.. JRM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAX I.O. NUMBER <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />N <br />z J %rYw` s� 10-yY <br />PROJECTADDRESS /E <br />Pilo <br />� <br />SIGNATu"E DATE <br />V <br />PLUMBING <br />CITY ROSINESS IICEN5E N0 <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />ATER <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />CLOSET (TOILET) <br />A'C-A-HNDLG UNITS-H.P. <br />PURGED AIR SYSTEMS-B.T.U. M E.A. <br />VATOR(WASH BASIN) <br />ff'BATHTUEY <br />ITHEATERS-R.T.U. M <br />OWER <br />DRYERS <br />TCHEN SINK & DISP - <br />_CLOTHES <br />TILATION FAN {:hM 41.f Eef <br />SHWASHER <br />r <br />RANGE HOOD <br />-r-' <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />, <br />CLOTHES WASHER <br />r <br />WOOD STOVE <br />r <br />UR.NAL <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />' <br />FIREPLACE INSERT <br />FLOUR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />r <br />_ <br />ROOF DRAINS-RAINLE <br />_ <br />r <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.)TC.) <br />r <br />r <br />r <br />r <br />SUB TOTAL S <br />_ <br />SUB TOTAL $ <br />- r <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />. VE E-Ivc VI " <br />VIVL-T: 1zoV <br />FRONTSETBACK <br />REAR SETBACK <br />G�7 <br />USE ZONF <br />TYPE OF CONSvT, <br />tFlIE <br />SIZE OFI LDG. /76 <br />F149 <br />SCUPANCYLOAD <br />F <br />PLANS APPp I1ED BY <br />DATEnal/ „ <br />.21"ly*-YKlL- <br />SIDE SETE! Kl <br />-(C7(=S IL-IU <br />PLAN CHECK !UMBER <br />O <br />WIN <br />FEE <br />VACANT SITE ,,� <br />❑ YES No <br />I� <br />FEES <br />BUILDING <br />CKEUPANCY <br />_3 <br />I W OIPASLLINGUNITS <br />I <br />PLUMBING <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />1EIGHTLIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />C. 41 tic S \/ / <br />UD REv/ I� N <br />u <br />