Laserfiche WebLink
APPLICATIOR`FOR CONSTRNCTILA PERMIT 0 — <br /> EAP EYerpwn TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everett - - <br /> BUILDING DEPARTMENT EATING SYSTEM: �{I GA5 ❑ELECTRIC U _ <br /> 10 <br /> i ! DEMOLITION <br /> - <br /> DEMOLITION X COMBINATION )(BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER � MAIL ADDRESS r CITY ZIP PHONE <br /> TENANT T ooRess y07_C ")L-Ir D� 'w-� Y c✓A '7-1Z.4 2- sa <br /> (, Jf y -e6yy/ <br /> ZIP PHONE <br /> ARCHIIECTOR DESIGNER MAR ADDRE;ISS COY ZIP PHONE <br /> �pT 14vt17 411171^/' >S�i�rLY�7n �✓A 9'033 F2Z -/71 y <br /> GENERAL COIITRACTpI MAN ADDRESS COY ZIP PHONE LICENSE <br /> O <br /> Tryn�rC Ts,alus. (SM _nviu►m) TRum 11099Ji4 <br /> l� H MECHANICALCONTRACTOR MAN ADDRESS CITY ZIP IB F. LICENSE <br /> aHN <br /> 3PLUMBNGCONTRACTOR MAI ADDRESS CITY ZIP CNONE LICENSE• <br /> MM�CC7 H <br /> A <br /> H 0 CLASS GF WORK <br /> 'O HH TX NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br /> VCONTACT PERSON AND PHONE NO <br /> I <br /> CONTRACT PRICE OF WORM <br /> DESCRIBE NORK AND SQUARE FOOTAr� T CJI ' GtF L^n �1'JLt in <br /> C E NN0.VED <br /> OH <br /> g elpas4 vd- new house (Ili yrs 0 s <br /> 0„ 0 PROPOSED USE OF BURGING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> z H 93 f l� l T I rtsl�r� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> a a l� LEGAL DESCR TION OF PROPERTY I SELOWO�R ATTACH�FOU�R�COPIESI PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> g y H LOT _ BLOCK OI li"bi,}17� ! / WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H I AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> L� PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOR-, FOR WHICH <br /> yLL03 __ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> H O Tn CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> SIGNATURE CONTRACTOR OR AUTHdNZED AGENT DATE <br /> A�Dz �0,14 Illre J.& _ x. <br /> PNOACCT ADDRESS - — <br /> APf11GNTS CITY BUSINESS t ICC-NSE NO AND BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> '� NO. TYPE OF FIXTURE OR ITEA1 FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET( NC-AHNDLG UNITS-H.IT <br /> BATHTUB __ _� FORCED AIR SYSTEMS--BTU. M E.A. <br /> LAVATORY(WASH BASIN) _UNIT HEATERS-B T.U. M <br /> c� / SHOWER �- CLOTHESDRYERS <br /> KITCHEN SINK A DISP VENTILATION FAN i <br /> / DISHWASHER _ _ RANGE HOOD <br /> LAUNDRY TRAY WP.TFR HEATERInk Asm _ <br /> CLOTHES WASHER WOOL STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> _ DRINKING FOUNTAIN FIREPLACE INSERT -� <br /> FLOOR DRAIN HEAT PUMP - <br /> IU'ai BACKFLOW PREVENTERS _ GAS PIPING E <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN - <br /> SINK(SERVICE-BAR,ETC.) <br /> w"II <br /> I I <br /> _ SUB TOTAL f - SUB TOTAL f <br /> PERMIT f PERMIT f <br /> TOTAL FEE f _y_ TOTAL FEE f <br /> FOR OFFICE USE ONLY: <br /> IIgNT fiETBACN REAR 9kifMCN SIDE 6ETBACA AN CRECK NUMOER FEE PECE-PI NO <br /> -3 <br /> USE ZONE 1.01 ARBA VACANT SITE FEES VALUATION FEE <br /> _ BUILDING <br /> TYPE DI CONIS M LOWANE TYPE M CONST ACIUAI Q.VMKI APOPKNIJImlls - <br /> PLUMBING i <br /> SIZE OF BLDO NO OF STORIES BASEMENT - <br /> MECHANICAL <br /> OCCUPANCY LOAD FIRE SMTNKLERS RE O U HEIGHILWITATION ADDITIONAL PLAN CHECK i <br /> 1 <br /> OTHER <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE i <br /> INTAKE BY MANS APPROVED BY CITY OF EVERETT PUBLIC WORKS - <br /> LOCAL SALES <br /> % (�/� :TAX CODE IS 9105 T EAL <br />