Laserfiche WebLink
APPLICATION FOR CONSTRUCI.ON PERMIT <br />�T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 • 259-8810 <br />Fl DI_MOLITION I l COMBINATION Pr BUILDING I I MECHANICAL 11 PLUMBING Il SIGN <br />PROJECT ADDRESS <br />/ / d jd" lam' K t <br />n1 PR MAII AIIDRFCS CITY ZIP PHONE <br />CEr.I f 6 tvl 1 -Tr f'J L l ltiAcfwi CvWrr k-e 9 rwl L.r L-60V L_ <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PI/ONE <br />C- tirP <br />GENERAL CONTRACTOR <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />'✓1L('�.n�// GNA.Cf <br />L131 HIFHL4?-A <br />lflf 'ir <br />17V-CL <br />LYL-7'/.fc <br />/✓AL4ac'yL L3o4/7 <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSER <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />CONTRACT PRICE OF WORK <br />3 (, `1 j <br />HEATING SYSTEM: Cl GAS rl ELECTRIC rl <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />f ab'f'-D C", A. C� CJj f if <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TPE GRANTING OF A PERMIT DOES NOT PRESUME -0 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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✓ 118.27 RCW AND 296.200 WAC. <br />X <br />PROPOSED USE OF BUILDING <br />L-310/Y-�` <br />LEGAL DESCRIPTIONPR fP PJV(SHOWN BELOW ORATTACH TWO COPIES) <br />LOT111 / I / BLOCK 3 (o OF lt RDA. <br />M op, (I.+r j 0 flf7t(--Tj- <br />PARCEL TAX 10. NUMBER — <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />C NiP <br />SIGNA URE DATE <br />/ L <br />CITY BUSINESS LICENSE N0. ? L/ 3 3 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — AMNDLG UNITS — H.P. <br />' <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I ' <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />' <br />SHOWER <br />UNIT HEATERS —B7.U. M <br />' <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />VENTILATION FAN <br />' <br />LAUNDRY TRAY <br />RANGE HOOD <br />i <br />CLOTHES WASHER <br />I <br />WATER HEATER <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />i <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />SINK (SERVICE — BAR, ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />' <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />' <br />cno nccLrc "cc nmi v. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMB)ER <br />FF.E <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />nYES n NO <br />BUILDING <br />�Q i�(] <br />Icy <br />HEIGHT LIMITATION <br />NO. OF DWELLING <br />SIZE OF BLWq I. <br />' <br />UNITS <br />PLUMBING <br />' <br />OCCUPANCY <br />NO OF STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />j <br />GROUP <br />I <br />ADDITIONAL PLAN CHECK <br />I <br />❑YES FT NO <br />FIRE ALARM RED <br />REASON <br />OTHER <br />i <br />FIRE SPRINKLER RED <br />REASON <br />SURCHARGE <br />STATE BUILDING <br />ISb <br />PUBLIC WORKS <br />TYPE OF CONST <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />-- <br />12 ' <br />TAX CODE IS 3105 <br />TOTAL <br />I �� <br />DATE <br />