Laserfiche WebLink
APPLICATION FOR CONSTRUCTION <br />PERMIT <br />the Evergreen everett <br />CITY OF <br />everett e <br />BUILDING DEPARTMENT <br />259.8810 TO BE COMPLETED IN INK - PLEASE PRINT <br />ARCHITECT OR DESIGNER MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />CLASS OF WORK <br />T -1 fl n ovoem Fl nPMnl InnN 11 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />TENANTIMPROVEMENTORINTERIO REMODELONLY <br />CONTACT PERSON AND PHONE NO <br />CONTRACT PRICE OF WORK <br />DESC91BE WORK AND SOU14 FOOTAGE INVGLVED <br />h0?- <br />PROPOSED USE o ,agaolNO <br />I H ERESY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIED HEREIN OR NOT, THE GRANTINGOF A PERMIT DOESNOT <br />LEGAL ED SCRIPTION OF PROPERTYISHOWNBEIOW OR ARACH fOURCOPIE51 <br />PRESUME TO GIVE AUTHORI -,Y TO VIOLATE OR CANCEL THE PROVISIONS OF <br />LOT BLOCK. OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />296 200 WAG <br />SIGNATUXGNATURE OF CONTRACTOR OOI/!N)�aO11HORIZ GENT DATE <br />APP ANTSCITY 4BU1111 CEN5•NO AND BUSINESS NAME <br />P/gJECT ADDRE <br />. 7� - s �g"" <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />_ <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_— <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS — RAI NLEADERS <br />EXHAUSTFAN <br />SINK(SERVICE —BAR. ETC.) <br />h2�L?VA zconI L / <br />SUBTOTAL $ <br />SUBTOTAL <br />$ <br />$ <br />PERMIT <br />$ <br />PERMIT <br />TOTAL FEE $ <br />TOTAL FEE <br />PEAfl SETBACK <br />$ <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />FRONT SETBACK <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />O YES ❑ NO <br />BUILDING <br />TYPE O`CONST. <br />OCCUPANCYGROUP <br />NO OF DWELLBIG UNITS <br />ALLOWADLETACTUAL <br />PLUMBING <br />SIZE OF BLLG <br />NO. OF STORIES <br />BSMT. <br />OCC LOAD <br />MECHANICAL <br />— <br />❑Y <br />OTHER <br />❑ N <br />HEIGHT LIMITATION <br />STATE BUILDING SURCHARGE <br />FIRE SPRINKLERS REOUIRED o YES ❑ No <br />STATE ENERGY SURCHARGE <br />PUBLIC WORKS <br />APPL'CATION ACC BY PLANS APPR BY <br />TOTAL <br />