Laserfiche WebLink
APPLICATIO�! FOR CONSTRUCTl�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 0 GAS � ELECTRIC � � <br />259-8810 ^ <br />❑ DEMOLITION ❑ COMBINATION l BUILDING Ci �9ECHANICAL �LUMBING ❑ SIGN <br />OWf'IEq ���� ���DR� _ V� ��CITY ZIP PHONE �� � ` � I �/ <br />C� <br />TENFNT MAILADDRESS CITV 21P PHONE <br />ISDb-.S2 ` v�✓ts�(L� <br />ARCHITECTORDESIGNER MAILADDRESS CITV 21P PHONE <br />CONTRACT PflI�E OF WORK <br />MAIL ADDRE55 <br />MAIL ADDRESS <br />FOOTAGEINVOLVED <br />uir ur <br />CITY ZIP <br />GTV � � ZIP <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />, PRNCELTAXI.D.NUMBER <br />� CONS7HUCTION IO�N LENDEH, �DDRESS, TELEPHONE NUMBEP <br />c <br />TYPE OF PIXTURE OH �TEM <br />WATER CL.OSET (TOILET� <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DIS� nVASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINC <br />FOR OFFICE USE ONLY: <br />� FRONTSETBACK REARSETBACK <br />I15E 20NE LOT AREA <br />iYPE OF CONSi. <br />SIZE OF B�DG, <br />OCCUPANLYLOAU <br />REASON <br />INTAKE BV <br />0 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FIFE EPflINKLF^5 RE� <br />FIRE ALARM REO'D <br />'LANSAPPROVEDBY <br />DATE <br />SIDE <br />YHUNt SIqItLIGENSE• <br />PHONE STATELICENSEt <br />PMONE STATE LICENSE M <br />� -�i6d P L��/L�r <br />CONTACT PERSON AND PHONE NO. <br />i HEREBY CF.RTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 1'O BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE!N 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 R[GULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEAFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />PLAN <br />M�A/HNDLG UNITS—H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />UNIT HEATER�B.T.U. M <br />CLOTHES DRYERS <br />VEN'; ILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />FXHAUSTFAN <br />�I VES ❑ NO BUILDING <br />U.NvaNCv NO Ofp�vF.�iNLUNi15 <br />eaour pLUMBING <br />BASEMENT MECHANICAL <br />G YES ❑ NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHtR <br />STATE BUIL�ING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />Fj <br />RECEIPT NO. <br />FEE <br />R <br />�N <br />n <br />�M <br />Oup <br />O <br />0 <br />