Laserfiche WebLink
I <br />APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: U GAS U ELECTRIC U _ -- <br />BUILDING DEPARTMENT <br />259-PB10 <br />❑ DEMOLITION ❑ COMBINATION L BUILDING L, MECHANICAL ! 1 UMBING 1 SIGN <br />OWNER H I r Gr, L1 DDRESS CITY ZIP PION <br />MAIL ADDRESS <br />CITY <br />ZIP <br />0 E +\ J <br />U <br />NER MAIL ADDRESS <br />CITY <br />ZIP <br />PH <br />CITY <br />ZIP <br />N5 ATE NSE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />IN <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY 1p PH LICENSE+ <br />PLUMBING CONTRACTOR MAILADDRESS CITY ,/'� 1 STATE LICENSE <br />CONTRACT PRICE OF WORK <br />DESCRIBE W R AND SQUARE FQDTAGE INVOL ED <br />O41AC i NANO PH01 ..O <br />• <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND OFOINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER PPEC FIED HEREIN OR <br />LEGALDES IPTIONOF PROPER" (SHOWN BELOWORATTACH TWO <br />I DI _l1 I <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />_ <br />LOT ) BLoeK of lJ�L1 ( <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />-- <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />— <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />—/ <br />PARCEL TAX I.D NUMBER <br />CONSTRUCTION LOAN LENDER. ADORF55. TElEPHONENUMEERj <br />PROJECTADORESS <br />`�1r � �a <br />scNArone DA*E <br />b1v 8VSM[SS LICEAiE I10 <br />_, � /✓� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR IT FEE <br />N0. TYPE OF EQUIPMENT FEE <br />A C—AIHNDLG UNITS—H.P. ' <br />WATER CLOSET (TOILET) <br />I <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS--B.T.U. M <br />T <br />' <br />SHOWER <br />C 0THES DRYERS <br />i <br />KITCHEN SINK. & DISP <br />i <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />I <br />1 <br />WATER HEATER <br />CLOTHES WASHES <br />I <br />_WOOD STOVE <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />FIREPLACE INSERT <br />' <br />DRIN': NG FOUNT <br />_ <br />FLOOR 09AIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PR ENTERS <br />I ' <br />--� <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />L <br />I <br />I <br />' <br />I <br />L <br />I <br />SUBTOTAL $ <br />I <br />i— <br />PERMIT $ <br />' <br />PERMOTAL <br />IT <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE U5t <br />UNL,Y: <br />PELEI TNO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />ER fkE <br />PLVI NUMBER <br />�7 �C <br />USEZONE <br />LOT AREA <br />VACANT <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />r� <br />❑ YES ❑ NO <br />TYPE O/CONSI. <br />NO, OF STORIES <br />pE6uwxtr <br />M). MPMWN6UVT5 <br />' <br />PLUMBING <br />—� <br />MECHANICAL <br />i <br />-- ' <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO D <br />BASEMENT � <br />V <br />❑ YES S%N0 <br />I <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANC LOAD <br />FIRE ALARM REOD <br />HEIGHT LIMITATION <br />P/A <br />OTHER <br />1 <br />REASON <br />STATE BUILi'NG SURCHARGE <br />PUBLIC WORKS <br />INTAKE -By <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE <br />