Laserfiche WebLink
APPLI 'i�'TION FOR CONSTIOCTION <br />PERMIT <br />the Evergreen <br />CITY OF everett <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK PLEASE <br />1-'PLEEASE P(JR,IIN,�T{ /LI 11 T�I /�'//�G�\[///�//��9(/ <br />MAIL g00n=S5 ' PHONE <br />D� / / /T/ I�l.l. U /OIU Z , / iTI Pl V l�C.�1 AJ `Q `/ / V f (_pa <br />ZIP <br />w <br />PHONE <br />CLASS OF WORK <br />❑ NEW ❑ ADDITION ERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR REMODEL ONE_ <br />CONTRACT PRICEOF WORK /� UL)J\ <br />CONTACT PERSON AND PHONE NO. <br />0� W � ARE FOOT.G�AyEO <br />'I 1 <br />PROPOEEOUSEOFBu ING/fir]/ <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. THE GRANTING OFA PERMIT DOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE 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 18.27 RCW AND <br />28E.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />� nht- ' %-96) <br />AP A ISGITY fl0 11 S SLICENS�N ANDBUSINESSNAME <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK _ OF — <br />PROJECT ADDRESS I � ^„ _ (1 <br />PLUMBING <br />Lof <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— 133015NEA. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />_ <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOODSTOVE <br />URINAL <br />_ <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />S <br />SUBTOTAL $ <br />PERMIT <br />$ <br />PERMIT $ <br />GCS' <br />DO <br />_ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />`.S <br />OO <br />FRONT SETBACK <br />DEARSETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPTNO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />TYPEOFBUILDING <br />ALIOWABLE/ACTUAL <br />ALLOWA LEIAC <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />PLUMBING <br />SIZE OF ULM <br />NO.OFSTORIES <br />BSMT. <br />❑ Y <br />❑ N <br />OCC LOAD <br />MECHANICAL <br />-- <br />U <br />OTHER <br />FIRE SPRINKLERS REQUIRED OYES ONO <br />"EIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />APPLICATION ACC BY PLANS APPR. B\' <br />— <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />5� <br />DQ <br />