Laserfiche WebLink
APPLICATIGA FOR CONSTRUCT JN PERMIT 00:. <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />DEMOLITION COMBINATION P_MER OMAIL ADDRESS n <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING MECHANICAL /I PLUMBING SIGN <br />TENANT <br />MAIL ADDRESS <br />CITY <br />ZIP ONEIZ it /�/ "' / - ✓ /( �� <br />PHi <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />GENERAL CON TRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE STATE LICENSE A <br />PLUMBING CONTRACTOR <br />�.nVA(_ MFCyl. <br />LidL ADDRESS <br />, �� 1 f�4 6��fdSfLC�B� <br />CITY <br />ZIP PHONE STATE LICENSE <br />CLASS OF WORK <br />(7L°LO?�Lo�ALMi 1�11 <br />NEW 16 ADDITION <br />ALTERATION RFRAIR <br />T1CN,nI mnr.� <br />----- <br />- ••���.+..•�� nrLmacnl L 1 bUILUING RELOCATION <br />CONTACT PERSON AND PHONE N0. <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDrAc-mR <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />kz <br />RUPTIO�F <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DES PROPERTY (SHOWN BELOWOR ATTACH FOUR COPIESI <br />LOT BLOCK 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 />-- <br />CONTHACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x <br />PROJECT ADDRESS <br />9 2 V i e r't, (, �c ,A(;e <br />AL P.rF <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 />NC—AIHNDLG 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. h1 <br />SHOWER <br />CLOTHES DRYERS <br />T-- <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLUW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />— <br />SINK (SERVICE —BAR. ETC.) <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />rvn vrrn,r UaC ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCH}ECI(NUMB FEE <br />a % <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT BITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />TYPE OF COSTS.ALLOWABLE <br />_ <br />TYPE OFCONSTACTUAL <br />OXUGSBOY <br />LNWP <br />NO Of MILLING UNITS <br />PLUMBING <br />� <br />SIZE OF BLDG. <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />OCCUPANCY LOAD FIRE SPRINKLERS REOD HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />ASON FOR SPRINKLERS <br />SPRINKLER <br />I ' <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />PUBLIC WORKS <br />' <br />TOTAL <br />TAX CODEIS 3105 <br />