Laserfiche WebLink
�Cz7� <br />JO ZyyT M <br />C H <br />The Evergreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />2598810 <br />APPLICATION FOR CONSTRUCTION <br />PERMIT <br />i <br />TO BE COMPLETED IN INK = PLEASE PRINT <br />MAIL ADORC59 LITY LI` MIONE <br />OWNER —� <br />MIONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP <br />GENERAL CONTRACTOR MAIL ADDREfi9 CITY ZIP PHONE LICENSE• <br />ZIP LICENSE• <br />MECHANICAL CONIRACTON MAIL AD -fat EG31P�i f">•[,YI`! PHONE <br />1625 F. VnriinnAo V*pWppOAAA(fZE.�a <br />PLUMBINOCONIRACIOR MMl AD01 if(!FQttl `Y iOLV1CITY ZIP MIONE LICEN9EA <br />2[6.2441 <br />CLAS90FNORK <br />❑ ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />❑ NEW ❑ ADDITION ❑ ALTERATION <br />REPAIR CONTACTPERSONANDMIONENO. <br />TENANIIMPROVEMENI ORIMERIOR REMODEL ONLY <br />CONTR CTPRCEOOQ <br />__— <br />DESCRIBEM VIAND SQUARE FOOTAU"WOLVE5 <br />(\1')v 1Q f�Alll <br />-- <br />rnoroseD uWILDI� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />SAME TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND <br />TA <br />KNOW THE <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE GRAN TING OF A PERMIT DOES NOT <br />TO GIVE AUTFIORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LEGAL DESCRIPTION PE TYISIIOWN BELOW on ATlAGI FORT OOME91 <br />PRESUME <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONS IRUCTION OR THE PER• <br />Lot BLOCK OF <br />OF CONSTRUCT ION. THAT I AM AUTHORIZED BY THE OW NER OF <br />FORMANCE MADE <br />THE WORK FOR <br />THIS L1827ON IS <br />WAND <br />AND IROPERTY COMPLYTWIITH THHEMSTATE CONTRACTORSHLAW <br />296.2DO WAG, <br />91GNATU OFCON�AGOn ORAUIIIOOIZEUAGENI DATE <br />X �XX/ �GLG.���c— 9'/ <br />AP LIf.ANISGTY RUBI E9SIIL NSE NO. AND BU9RIE55 NAME <br />PTIOJECT ADDRESS <br />r�� nL�nlslTl��l - it V <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C — AMNDLG UNITS — H.P. <br />— <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS— BT.U. M EA <br />_ <br />BATHTUB <br />— --- <br />UNITHEATERS—RIM. M <br />LAVATORY(WASHBASIN) <br />__ <br />CLOTHES DRYERS <br />_ <br />S40WER <br />- <br />VENTILATION FAN <br />_ <br />KITCHEN SINK& DISP. <br />DISHWASHER <br />RANGEHOOD <br />WATER HEATER <br />-- <br />-- <br />LAUNDRY TRAY <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE&CHIMNEY <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />— <br />— <br />BACKFLOW PREVENTERS <br />GAS _ <br />_ <br />ROOF DRAINS— RAINLEADERS <br />EXHAUSTF FAN <br />SINK ISERVICE — BAR. ETC.) <br />SUBTOTAL $ <br />SUBTOTAL <br />— <br />5 <br />_ <br />-- 5 <br />PERMIT <br />PERMIT <br />$ <br />— & iU 7L� <br />TOTAL FEE <br />TOTAL FEE <br />FEAR SETBACK <br />S <br />910E SC1BACK <br />PIAN CHECK NUM)ER FEE RECElrT NO. <br />FRONT SETBACK <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />USEZONE <br />❑ YES ❑ NO <br />BUILDING <br />TYPE OF CONSi. <br />OCCUPANCYGROUP <br />NO OF DWELLING UNITS <br />— <br />ALLOWABLEIACTUAL <br />PLUMBING <br />slzE of eLDG. NO STORIES B9MI. <br />OCG LOAD <br />MECHANICAL <br />�' <br />U Y <br />ON <br />HEIGHT LIMITATION <br />OTHER <br />FIRE SPRINKLERS REWIRED DYES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />APPULATION ACC. BY PLANS APP0.0Y <br />TOTAL <br />'� <br />O <br />