Laserfiche WebLink
�••� ��•. 1 <br />!�, �:_��11 <br />APPLICt+•TION FOR CONSTR��TION <br />PERMIT <br />fhe Evergreen everett <br />CITY Of� <br />everett e <br />BUILDING DEPARTMENT <br />259-BB10 TO BE COMPLETED IN INK— PLEASE PRINT <br />�%)� E Sh��7C, MAILBA`/Szi '��ve,�el cGder�l% Z�9�2Uy P�o3S3-6oz� <br />mueui MAII <IlORE55 CITY ZIP PNCNE <br />ARCMITECTOPOESIONER MAIIR�ONESS CItY ZIP PHONE <br />OENEOALCONTflACTOR MAILR�OFESS CIiY ZIP PNONE 4CENSE� <br />Se/� <br />MECMNNICALCONTRRCTOfi MAILAOORE55 CIiY 21:' PMONE LICENSE• <br />PLUMBINOCONTR�CTOR h1AILAp�FE55 GIiY ZIP PHONE 4CENSE• <br />fel�' <br />CLA3S OF WOflN <br />❑ NEW ❑ AD�ITION � ALTEHATION ❑ REPAIfl ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />PqWE <br />�ndU °—" <br />I I t� <br />V /'J !/n / �x $ �?i (� <br />...,,._"_'""_. _'.'_...� � � <br />z � i4 s . <br />LE�AL DESCRIPTIUN Of PRUPERTY�S N BELOW OR ATTpGH FOUN WF <br />, �or_� BLOCN or <br />5• IS� � <br />- 6f L_ O 7' / oF %�L1tr eF S� / <br />1 �� _ <br />Sy z S � �vz �,�J <br />PROJECTA��RE55 <br />PLUMBING <br />� NO. TYPE OF FIXTURE Op ITEM <br />! '2 WATERCLOSET�TOILCq <br />� BATHTUB <br />� !— LAVATORY�WASH BASIN) <br />y SHOWER <br />� y KITCHEN SINKB DISP. <br />� DISHWASHER <br />LAUNDFYTRAY <br />� CLOTHES WASHEfi <br />� URINAL <br />� DRINKING FOUNTAIN <br />l <br />� FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />� ROOFDRAINS—RAINLEADERS <br />� siuu�sFavinc—weo Gm� <br />FRONTSETBRGN <br />. Zp <br />• USEZONE <br />. -� �3 <br />' lYPEOFCONST. ,I <br />AILOWABLE/ACTl1AL � !V <br />7C�1� _ <br />SREO B�Of3. <br />x � x yo a$o <br />IV, <br />� HEREBY CEATIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOWTHESAMETOBETRUEANDCORR[CT.ALLPROVISIONSOFLAWSAND <br />ORDINANCES GOVcRNING THIS TVPE OF WORK WILL BE COMPLETED W�TH <br />W HETHER SPECIFItD HEREI IJ OR NOT. THE GHANTING OFA PERMIT DOES NO7 <br />PRESUME TO GIVE AU7HORIN TO VIOIATE OR CANCEL THE PHOVISIONS OF <br />ANYOTHER SiATE OR LOCAL LAW REGULATING CONSTr7UCTION ORTHE PER� <br />FORM.ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS M�DE <br />AND I COMPLY WITH THE STATE CONTRACTORS LAW 1827 RCW AND <br />296.200 WAC. <br />SIGNATUREOFCONiBRGiOPOBAJiHORREOFGENi OATE <br />X l,,/h? �.r �,r�G � ou, �. PI- v- 6- 8`� <br />RPPLICr1NLS GITY BUSINE55 UGENSE ND. NND UUSW E55 NRME <br />MECHANICAL <br />FEE NO. <br />PERMIT 5 <br />TOTAL FEE 5 � <br />flFARSETBACN SIOESETBACN <br />/ <br />� Z� � �.� <br />IOiAREA VPCr1NiSITE <br />❑ YES �NO <br />z� zso <br />OCCUPANCY�ROUP NO.OFOWELLINOUNIiS <br />�� � 3 <br />�- NO.OF SiOdIES BSMT. OCG LOAD ` <br />� � N �_ <br />NEIGHT LI�IITFiION <br />❑ YES ❑ �_ <br />PUNS PPPR. BY <br />�%-� <br />TYPE OF EUUIPMENT FEE <br />DLG UNITS— H.P. <br />7 SYSTEMS — B.T.U. M EA <br />UIYII IICNICnJ� O <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIREPLACE 3 <br />FIREPLACEINSERT <br />EXHAUSTFAN <br />PUNCMECK MBEP <br />�a arq3o <br />FEES <br />BUILDING}3$O�C �L� <br />PLUMBING <br />MECHANICAL <br />STATE BUILDING SURCHARGE <br />STA7E ENERGY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUBTOTAL 3 <br />TOTAL <br />Z.3�0 <br />