Laserfiche WebLink
� <br />,, ������� ���" <br />,; � <br />APPLICATIOI�1 FOR CONSTRUCTION �1�9�' � '';�#� <br />_ . .. . <br />CITY pF E� .... . everett >�! <br />fhe Evergreen . .. ........... '„ti <br />cirvoF Public r,'orkSERETj' � .{�; <br />everett �ePt. i�l <br />BUILDING DEPARTMF�NT ,i; <br />259-8810 TO BE COMPLETED IN INK—PLE�A E PRINT , <br />❑ DEMOLITION ❑ COh�BINATION ❑ BUILDING j.Y1�AECHANICAL ❑ PLUMBING ❑ SIGN ".�' <br />O�JIEv"'"' 1 l'�{Lt/i I WM�LADD`"IS'� ��� I.IVy Cli�( �V`�/ZI� i (7�O 'V � `"� 1 � �� � l �. � � .. <br />/V <br />TENANT MAILADOOESS (;ITY ZIP PNONE ' <br />AHCHITECT Ofl DESIGNER MAIL AOORESS CITY ZIP PHONE „ <br />GENERALCONiq�CTOR MAILAD�RE55 CITY 21P PH011E LICENSE■ , <br />MECHANICA�CONTMCTOR MAI�AD�flESS <br />�UAIIDL ��IC �� (030 <br />PLUM�INOCONiRACTOR MAILRDORE55 <br />CIIY <br />• <br />,. , ��n. <br />. "� <br />CUS50° WOflK � <br />I..I NEW ❑ ADOITION I�AL7EIiAT10N Cl REPAIR CI DEMOLITION I I WOODSTOVEIFRPLINSERT ❑ BUILDINGRELOCATIJN <br />IEN�N� IMPqOYEMENT ON 141 E <br />CONTRRCT PPICE OF WORK: t <br />DfSCRiBE WORK �Np SOURRE <br />0.lnn , <br />� <br />LEGAL DESCPIPTION OF PROPI <br />LOT ,,} BLOCN <br />.'In� �/'1'r./_L�f <br />PLUMBINO <br />COPIES) <br />OF _ <br />O � <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />LAUNDRYTRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—B�R. ETC.1 <br />FRONTSETBACK <br />USE20NE <br />SUB 70TAL <br />PEFiMIT $ <br />TOTAL FEE 5 <br />FlEARFETBACN SIDESETBACK <br />l0T AREA <br />ttPEOfCON5I.,1llOWABIE I 7YPEOFCONSLACIOAL <br />5¢EOFBIDC. I NO.OFSTORIES <br />OCCUPANCYLOAO <br />RE�SON FOR SPRIHNIEqS <br />APPLICATION ACC. OY <br />� <br />FIRE SPflNNLEAS RF.OD <br />CI YES (l NO <br />PLANS APPROVEO BY <br />CONTACTPEPSONPNDPHONENO. <br />i ntntnr ctnnrr inAT i��AVE REAO AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE'RUE AND CORRFCT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WURK WILI 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 QP ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br />PERPORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE �'I� <br />OWNER CF THIS PROPERTY TO PERFORM THE YJOFK FOR WHICH . <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE ' <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATtI EOFCONiRqCipq�UTH� OflIZEOAGEHT � ATE � ���� <br />Wil/l1!> I ��jG <br />X <br />U� �� <br />APPLICANTSQ�YOUSINESSLICENS O.ANDBUSINESSNAIAE � � <br />NO V � TVPE OF <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIflEPLACE 8 CHIMNEY <br />FIflEPLACE INSERT <br />GAS PIPING <br />EXH�USTFAN <br />VACANi SITE FEES <br />❑ YES (.] NO BUILDING <br />aarexcr xos�ow[uixcuxns � <br />GflWP <br />PLUMBING <br />enSEUEr+r MECHANICAL <br />O YES ❑ NO <br />HEIGNTUMI7ATION OTHER <br />STATE BUILOING SURCHAflGE <br />STATEENEflGVSURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES — <br />TAK CODEIS 3 05 TOTAL <br />SUB TOTAL $ ( � <br />PERMIT $ , <br />TOTAL FEE $ � <br />FEE RECEIPTNO. <br />VALUATION FEE <br />i <br />� <br />I <br />� <br />r: <br />I ;, <br />a <br />