Laserfiche WebLink
APPLICATION FOR <br />everett CJNPE M TTION <br />DEPT, OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT. WA9B201 <br />❑COMBINATION ❑ BUILDING <br />❑MECHANICAL <br />❑PLUMBING <br />PERMIT NO. <br />"'IMAIL <br />ADDRESS <br />� CITY <br />III <br />PHONE <br />,f/ <br />/so n 22,01 <br />94, 4*04 "tu <br />k 99 w <br />3s i z V 9L <br />ARCIIIIICT OR ULSIGNIR <br />RU1TL AODRUS <br />CITY <br />ZIP <br />PHONE <br />Ss}m <br />111. <br />GINIMICONIRACTOR <br />MAILADURUS <br />CITY <br />ZIP <br />PHONE LICENSEE <br />MICHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP MONT LICENSER <br />PI UNITING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE R <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR KDEMOLITION ❑FENCE ❑SIGN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION Of WORK <br />DISCRETE .YORK <br />Ain d.IF Rn� /in..RLN il!...Pssrhe or— l3vRR F 0,618 APle— <br />PROPosm usH of RUDE""O <br />6. <br />I HLREBY CLRTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOW THE SAME TO HE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK 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 OR AUTHORIZED AGENT DATE <br />LLCA1 DESCRIPTION OF PROPIRTY ISHOWN RUOW OR ATTACH FOUR (()PIER) <br />1R_�/ <br />LOT /�T oINQLaaou� Sr <br />um anRl.� yy <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE Of FI%[URE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />IEE <br />,S ATIR ( LOSE T 11011E T I <br />AIR COND. UNIT S-H.P. EA <br />IIAIHTUB <br />REFRIGERATION UNITS-H.P. EA <br />LAVATORY IWASH BASIN) <br />BOILERS-H.P. EA <br />SHOWER <br />GAS FIRED A . UNITS —TONNAGE EA <br />KITCHEN SINK I DISP <br />FORCED AIR SYSTIMS—B.T.U. M 6: <br />DISWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—R T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VI NTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C F' M <br />_ <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS— RAIN[ ADI ITS <br />METAL FIREPLACE B CHIMNEY <br />SINK (SERVICE —BAR. FTC) <br />SUBTOTAL <br />SUB TOTAL E <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />SIDE YARD SETBACK <br />STREET St TRACK <br />REAR YARD SETBACK <br />I'LAN CHECK NUMBER <br />PLAN <br />FIE <br />CHECK FEE <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FAFS ONO <br />FEES <br />VALUATION <br />FEE <br />TYPE OF CONST. <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />512k OF BLDG. <br />NO. OF STORMS <br />MAX OCC LOAD <br />PI UMRING <br />FIRE ZONE <br />BASEMENI <br />BIORISTMS <br />FIRE SPRINKLERS <br />RIQUIRED <br />IlYls [-INC) <br />MICHANICAI <br />APPROVALS <br />IV <br />DATE <br />OTHER <br />1. ENVIRONMENTAL CHECK LIST <br />PENALTY <br />Ii B l <br />SII m1,n <br />2. BUILDING PLANS <br />TOTAL <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PEHMIT <br />7 fIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />S GRADINGIIKCAVATION&CLIARINGIGRUIIIIING <br />-- <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />I HEALTH DISTRICT <br />APPIH`AYNIN ACC BY PI ANS 1-1111111 1 <br />