Laserfiche WebLink
APPLICATIC 1 FOR CONSTRUCT" )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: JAI GAS <br />J ELECTRIC <br />] <br />BUILDING DEPARTMENT <br />v <br />259-8810 <br />DEMOLITION <br />i COMBINATION <br />K BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />AlcLw viol w�..�_� <br />�� <br />as i IGyfJpV <br />� (� <br />c.%v if- <br />3S5 <br />4-7 a, <br />TENANT <br />MAIL ADDRESS <br />_DJTYt <br />C <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL <br />Ati RES�Y <br />IPl <br />P3�MJA6; <br />�C�ONTRACT�iIAAIL <br />�w! <br />�GJ <br />r 1--UI�L' <br />..1 <br />1\.0 <br />10x7J <br />xliz a$1CL <br />�A9 <br />MECHANICAL CONTRACTOR <br />/_ <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PPRIICCE OF WORK dC, <br />DESCRIBE �WO KAND SOU RE FOOTAGE INVOLVE <br />cw44iiCu /Au Al <br />6SA%&9aLs <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. ALI. <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 WAG. <br />�/%� <br />X,Q, AI/O yiL6�'[rs <br />PROPOSED USE OF BUILDING <br />V, <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWOCOPIES) 1 <br />LOT BLOCK -�— OF .��� <br />PARCELTAK ID. NUMBER <br />.Ui 7n <br />CONSTRU TION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />w <br />C9I III NI 511 iCIv:,t <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-AMNOLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />) <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC.) <br />' <br />_ <br />1 <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: OOn.ilos <lunv.e Z1210 UuC _ <br />FRONT SETBACK ! <br />REAR SETBACK—•_'/ <br />SIDE SETBACK �/ <br />PIAN LHF K��DEH <br />/) <br />16E�f�G, <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITES <br />❑ YES LJ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING �6 5.. PUK- <br />TYPE OF CONST <br />NO. OF STORIES <br />0=mr <br />xx-3 <br />xopwauwa mars <br />PLUMBING <br />(�(� <br />SIZE OF BLDG. <br />00A) <br />FIRE SPRINKLERS RED <br />NO <br />BASEMENT <br />CI YES 1 NO <br />MECHANICAL <br />' O� <br />ADDITIONAL PLAN CHECK <br />_ I <br />OCCUPANCY LOAD <br />(.� <br />FIRE ALARM REGD <br />O <br />HEIN <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />T 1 <br />INTAKE BY <br />PLANS APPROVED BV <br />J I4 <br />DATE'15- �tf. <br />CITY OP EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />�'— <br />TOTAL <br />p <br />O ��D <br />