Laserfiche WebLink
APPLICATICA FOR CONSTRUCTON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, WA 98201 •257-8810 <br />❑ DEMOLITION D-COMBINATION "UILDING (9-MECHANICAL f9 PLUMBING ❑ SIGN <br />PROJECT ADDRESS //- ro �/ <br />�3�1'1 4� sr. <br />3.NER MAIL ADDRESS CI}Y ZIP PHONE <br />(•orxrz-r✓ 8k,!2..r /1714-s3a/f C21/--b` gslofz `/35 137 5-273 <br />iEIANT MAIL ADO PEss cm z✓' PHONE <br />ARCHITECT OR DEFINER <br />PAILADDRESS <br />CITY Z' <br />PHONE <br />J <br />GENERAL CO. AC OP <br />LUILACORESS <br />CITY ZIP <br />PHONE STATE LICENSE• <br />nr--2rzFAl <br />F <br />6,1THlaI � <br />MECHANICAL CONTRACTOR <br />UAIL ADDRLUS <br />CITY ZN <br />PHONE STATE LICENSE <br />CONTRAcry EOF Wows <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _ <br />DESCRIBE WORK AND' FOOTAGE INVOLVED <br />) 17 <br />CONTACT PERSON AND PHONE NO <br />— <br />I HEREBY CER-IFY 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. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE (1F CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR:A THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA R LAW 10.27 RCW AND 296.200 WAC. <br />x�� � oG ry Oi <br />PROPOSED USE of BUILDING <br />S� Li wA F% <br />DN LEGAL DEEGRIPTIOF PROPERTY I OWN BELOW OR An HIWO colvEsl <br />LOTBLOCK OF__. <br />44-039 <br />___ <br />PARCELTAx m. NUMBen <br />?9l 2 zz <br />N <br />COIISipnl�;iICNI ANL HOER. ADDniS5.1E1EP11pNE NUMBER <br />/l �J� <br />{ <br />SIGNAIU E IF DATE <br />CRY BUSINESS LICENSE NO <br />PLUMSIIIG <br />MECHANICAL <br />NO <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE 01 EQUIP41ENT <br />FEE___ <br />W, TER CLOSET (TOILET) <br />r,C—AIHNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />_ <br />JNIT HEATERS <br />KITCHEN SINK 6 DISP <br />/ <br />CL'OTHES DRYERS <br />DISHWASFER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />! <br />_ <br />I <br />CLOTHES WASHER <br />WOOD STOVE <br />~— <br />_ <br />URINAL <br />_ <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR. DRAIN <br />'AS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />$ <br />SUBTOTAL S <br />PERMIT <br />S <br />PERMIT S <br />TOTALFEE <br />S <br />TOTALFEE $ <br />FnR nFFICF IIRF nNI V' VIA) /OL' —( <br />FPONL SETBACK <br />z c. <br />REAR SETBACK <br />SIDE SEIBACIL_ <br />PUN CHECK NUMBER <br />If— / ob - 003- <br />FEL <br />RECEIPT NO <br />USE / <br />LOT A <br />veC.WTSRE <br />Ca'IES C1 NO <br />FEES <br />VALUATION <br />FEEFEE <br />BUILDING <br />143,27e <br />11LIO14T UMn N <br />2 <br />INOa WELLING <br />uNITS <br />SIZEOF 4LDGTI <br />Z/1 {Y , s <br />TBAASUMMENT <br />PLUMBING <br />OCCUPANCY <br />ONL y -.1 <br />Iq R STORIES <br />1 'L <br />OCCUPANT LOAD <br />FTYES ,All., <br />MECHANICAL <br />ADBRIdNLPUNCHECK <br />FIRE SPRINKLER RED <br />REASON <br />OTHER <br />FIRE ALARM RED <br />REASON <br />STATE BUILDPD SURCHARGE <br />TYPE OF :ONST <br />_� <br />PIMNSAPUROI <br />BATE 6 <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />