Laserfiche WebLink
H <br />N �IIII-----HIIII <br />Hz <br />so <br />y�wg <br />t" F3 <br />rA H <br />0 1 rAA <br />Oca <br />r.1 <br />�\ APPLICATIO.. FOR CONSTRUCTLIN PERMIT L•cl°ILII <br />the Evergreen TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett HEATING SYSTEM: gGAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRi S TY ZIP PIZ <br />1 <br />i T1- <br />TEN U MAIL ADDRESS CITY U ZIP PHONE <br />ARJJHITECT OR DESIGNER MAIL ADORCSS CITY ZIP PHONE <br />N/l^M(' gFC "\�, aCoC�S p1r 1�1��"' rIV _C 1� C/L LI�E�YI ( ) <br />MECHANICAL CONTRA Ok MAIL ADDR11Efl�SSL[-u CITY 21 v1p PHONYE /q1 141 LICENSE t� /''4� <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE JL_LICEENS/E F l// <br />CLASSOF WORK <br />NEW ADDITION I X ALTERATION REPAIR ❑ DEMOLITION WOODSTOVE/F9PL INSERT BUILDING RELOCATION <br />CONTRACT PRICE OF WORK. <br />/`�I��- <br />CONTACT PERSON AND PHONE NO <br />DESCRIBE W RK AND SQUARE rOOTAGE INVOLVED <br />T <br />PROPOSED USE OF BUILDING u <br />u <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW 1HE 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 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />NPROJECT <br />JlkANlSlJlTT'8l4SNSIlfbENSEO AND BUSINESS NAME <br />LEGAL DESCRIPTION OF PROPERTY ISHOWNBELOW OR ACN FOUR COPIES) <br />LOT BLOCK OF <br />ADDRESS. <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 />A C—AiHNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. E.A. <br />_ <br />LAVATORY (WASH BASIN) <br />1 <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK d DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />1 <br />WOOD STOVE <br />_ <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />' <br />_ <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />1 <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />1 <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />_ <br />1 <br />�T <br />1 <br />T- <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />PERMIT $ <br />1 <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />III <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST. ACTUAL <br />OPXJK Y <br />W ff w UNc UNITS <br />cnwr <br />PLUMBING <br />� <br />SIZE OF BERG. <br />NO, OF STORIES <br />BASEMENT <br />MECHANICAL <br />1 <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOAD FIRE SPRINKLERS RED HEIGHT LIMITATION <br />OTHER <br />i <br />T <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />