Laserfiche WebLink
TAE EYBroI»R �APPLICATION FGit EyETEB <br /> CITY or CONSTRUCTION <br /> everett PERMIT <br /> TO BE COMPLETED IN BLACK INK- PLEASE PAIN, <br /> BUILDING DEPT. <br /> 259.8;45 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL Cl PLUMBING ❑ SIGN <br /> OW FR MML ADO iE39 CITY 21P PHONE <br /> �Xzoa }JJ-dsfi <br /> wTECT ORO SIGNER MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADORERS CITY ZIP PHONE LICENSE <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE F <br /> PLUMBINGCONIRACTOR MAILADORESS CITY ZIP PHONE LICENSE F <br /> CLASS Or WORK <br /> NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br /> VF WAIION DiWp"Kel; PL;LAB <br /> OE96RIB WQRK <br /> 0A` <br /> IP11 Or BUILDINn <br /> .r I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br /> 7"1 R.AVG PLICATIONAND KNOW THE SAMETO BE TRUEANDCORRECT.ALL <br /> LEGAL DESCRIPTION Or PROPER 11,%NOWN BELOW OR ATTACH FOUR COPIES) PROVISIONSOF LAWSAND ORDINANCES GOVERNING THISTYPE <br /> OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br /> LOT—BLOCK OF <br /> ERE•LOT_BLOCK—OF IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> GIVE TO VIOLATE OR CANCEL THEFLS <br /> ANY OHEROST'ATETY OR OCALLAW REGULATING CONSTSROUCTION <br /> OR THE PERFORMANCE OF CONSTRUCTION. <br /> \\ �)NA Q((ff1 / J�J/LI SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE/LI SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X t" P t <br /> ."OIECT ADDRESS APPLI A rBCITY BUSINESSLICENSE NO <br /> C_ <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FIXTURE FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET TOILE AIR COND.UNITS—H.P.EA <br /> BATHTUB REFRIGERATION UNITS—H.P.EA <br /> _ LAVATORY WASH BASIN BOILERS—N.P.EA. <br /> SI/OWER GAS FIRED AC.UNITS—TONNAGE EA <br /> KITCHEN SINK t DISP FORCED ATR SYSTEMS—B.T.U. MEA. <br /> DISHWASHER WALL HEATERS—B.T.U. M <br /> _ LAUNDRYTRAY UNIT HEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVE COOLERS <br /> WATER HEATER CLOTHES DRYERS <br /> URINAL VENTILATION FAN <br /> DRINKING FOUNTAIN RANGE HOOD <br /> FLOOR DRAIN AIR HANDLING UNIT— C.F.M. <br /> VACUUM BREAKERS STOVE <br /> ROOF DRAINS—RAINLEADERS METAL FIREPLACE A CHIMNEY <br /> SINN SERVICE—BAR,ETC. WOODSTOVE/FIREPLACE INSERT <br /> _SUB TOTAL SUB TOTAL S _ <br /> PERMIT_ i PERMIT S —_ <br /> _ TOTAL FEE t TOTAL FEE t <br /> THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br /> FRONT s.IBA_CK FILAR SETBACKSIDE SF IBALK PLAN CH.OK NUMBER PIAN CHECIKpI EWE <br /> W LN s/ I ` FEE/O�= TV/To) <br /> USE ZONE LOI ARIA OIC <br /> / //� OYES)11`00 VACANT FEES _ VALUATION FEE <br /> 9,-L, <br /> TYP101 CONST UI:CUPANCY GROUP NO OF DWELLING UNITS C����Yy/YA <br /> jr—� � _/ _~ BUILDING S f sm- <br /> SRF Or DI UO NO or STORES MAX.OCC LOAD - <br /> 4ril, A� I PLUMBING <br /> MECHANICAL _ <br /> FIRE SPRINKLERS REQUIRED 0FIRE SPRINKLERS REQUIRED YESRNO <br /> DINER <br /> PENALTY <br /> APPLICATION ACC BY PUNS CHECKED BY APPR FOR IS SUANCE BY <br /> TOTAL <br /> f�J <br /> iVeeLgoo 1`412 ah?00ks <br />