Laserfiche WebLink
1r <br />L <br />APPLICATION E®p <br />the Evergreen <br />CITY OF CONSTRUCTION <br />CITY <br />everett <br />everett PERMIT <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT, WA 98201 ❑COMBINATION BUILDING ❑MECHANICAL ❑ PLUMB ING PERMIT NO. <br />OWNER MAIL ADDRESS CIiY ZIY PIIONL <br />..... ..♦nnoca CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE{ <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSk{ <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VA:UATION Of WORK <br />DkSCRI♦E WORK <br />g ♦ 1 <br />l n U <br />PaovD<Lo USE LN BUILCrrNC <br />LI <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORN: WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE. OF CONTRACTOR O AU ORIZED AGENT 7OATT -\ <br />(y�� / 1 5 v �r?_ <br />tiJ`-U"`-" <br />LEGAL DESCRIPTION OFP PROPERTYBEIOW OR AT cH Fovac PlEsl' <br />�� <br />LOTI F �/ — r (OCK3� � of U" <br />100 ADDRESS <br />PLUMBING <br />MECHA ICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOLIET) <br />AIR CONE) UNITS -HP EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P EA <br />LAVATORY (WASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A.C. UNITS -TONNAGE EA <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B T.U. M EA <br />DISWASHER <br />WALL HEATERS-BiU M <br />LAUNDRY TRAY <br />UNIT HEATERS-8 T U M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- CENT <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS —RAINLEADERS <br />METAL FIREPLACE A CHIMNEY <br />SINK (SERVICE —BAR, ETC 1 <br />SUB TOTAL <br />SUR TOTAL S <br />PERMIT <br />3 <br />PERMIT 3 <br />TOTAL FEE <br />S <br />TOTAL FEE $ <br />SIDE YARD SETBACK <br />STREET SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FtC <br />CHECK FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />DYES DNO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO. OF DWELLING UNITS <br />BUILDING <br />5 <br />SIZE OF BIDG <br />NO OF STORIES <br />MAX OCC LOAD <br />PLUMBING <br />FIRE ZONE <br />BASEMENT <br />BEDROOMS <br />FIRE <br />SPRINKLERSREQUI <br />E1YFS ❑NO <br />MECHANICAL <br />APPROVALS <br />BY <br />OAT[ <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />L. N <br />SIC 101W <br />7. BUILDING PLANS <br />TOTAL <br />B. FIRE HYDRANT <br />4 FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATEDON THIS SPACE)THIS IS YOUR PERMIT <br />5 GRADINGIEXCAVATION B CLEARINGIGRUBBING <br />6 DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE BY <br />9.1-79 <br />