Laserfiche WebLink
:;% <br />APPLICATIO j' FOR , CONSTRUCT► :1N PERMIT <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />UM Everpmen <br />CITY OF <br />eve rett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />everett <br />e <br />I I DEMOLITION <br />CI COMBINATION w, BUILDING <br />Li MECHANICAL <br />L] PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />[�Lx�r��� <br />TAC �/� <br />ZS IMktaS> A- <br />9�Zo3 <br />Zi5-69�3 <br />wet <br />_ <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT On DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE IT <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CItY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />CLASS OF WORK <br />- <br />✓ ., n.Io I I noAAnl ITInM <br />I 1 wnrTOST°VEIFRPL <br />INSERT ❑BUILDING RELOCATION <br />CONTACI PERSON AND PHCNE NO. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />40k-- / 37 ° <br />rnogpseD USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />�� 7Dt�..�7 �- L <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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />PEDAL DESCRIPTIONIi—PnOPE f1LY TSIIOWN BELOW On AT IACH FOUR COPIES) <br />OF <br />LOT ( BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />Ajb Z <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI ION 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 WAG. <br />OR AUTHORIZED AGENT DATE <br />OF CO/�N G /2—/ 9 1 <br />_ <br />SIGNATURE / <br />//IRAACIOR <br />PROJECT ADDQRESS �/S- n57- �`�",7,A <br />,'7/C �V <br />nUSINc55lICENSE NO. ANO BUSINEBS NAME <br />?AN! <br />'O <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AIG—AMNDLG UNITS—H.P. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />�— <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />_ <br />1 <br />WOOD STOVE <br />' <br />URINAL <br />' <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />I <br />SINK (SERVICE —BAR, ETC.) <br />1 <br />SUB TOTAL $ <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />PERMIT $ <br />T4 -AL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SE TRACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />FEES <br />VALUATION <br />FEE <br />use ZONE <br />LOT AREA <br />VACANT SHe <br />BUILDING, <br />PLUMBING <br />f <br />1 GU <br />' <br />' <br />TYPE Of CONTS. AROWARIE <br />TYPE OF CONS. ACTUAL <br />(KfUPAxcY <br />rnouv <br />xO arMUlx4 ux16 <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />i <br />00 <br />OCCUPANCYLOAD FIRE SPRNKLERS R E I IF IGII T L IM I TAT ON <br />REASON FOR SPRINKLERS <br />'1THER <br />STATE BUILDING SURCHARGE <br />e( r-ff <br />7 , v <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 />y y ; r <br />