Laserfiche WebLink
APPLICATION FOR CONSTRUCTI.JN PERMIT L•VL'TE'II <br /> theEHeR,,Iw;o TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everettH[ATINCSYS,EM GAS UELECTRIC U —� <br /> BUILDING DEPARTMENT — - <br /> 259-8810 <br /> /OT•�� D�EMOLI�TIIOO�N)(��+ / �CO�MBINAATII_'Oy N��/�� BUI <br /> ILL <br /> +DING ECHANICAL�7 pPLUMBING SIGN <br /> �•KJ /r'%✓vo-J Ally zl.�..A/�/a/(/c4e n�C ,m y'B.eoC1 PHONE ADDRESS CITY zip / �� —,3 <br /> TFNANT MAIL ADDRESS CITY IIP PHONE <br /> ARCHITECT OR DESIGNERMAIL ADDRESS CITY ZIP PHONE <br /> ZIE , )L.e j CS' 20/0 •7s 'AS'4 pigim—• yzos 3r3 -os•13,/ _ <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br /> A &a! <br /> MEC�HANIICAL L— OV— TON MAIL ADDRESS CITY ZIP PHONE LICENSE 6 <br /> PLUMBING CONTRACTOR MAIL ADDRESS CRY LIP PHONE LICENSE <br /> —/b .Bis as�.�//J — <br /> RLASS OF WORK <br /> NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT :. BUILDING RELOCATION <br /> C TACT PERSON AND PHONE NO(� <br /> CONTRACT PRICE OF WORK _ /J /FJY7J�e � -- 74•/L 336_5_ <br /> DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED Aa <br /> PROPOSED USE OF BUIL ING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPERTY ISHOWNBELOW OH ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> Lor BLOCK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> E� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> /,07. J P zs•, OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS <br /> /�/��LAW 18.27 RCW AND 296.200 WAC, <br /> SIGNATURE OF�/i�:OyTR TQE'Oq AUTHORIZED AGENT DATE (�� <br /> TR ,,''/�/J(f/l/,¢/Cs////q/'// II// v+ <br /> OFx .7 /V 1'2� U _ APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS 74AME <br /> PLUMBING V MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE AD. TYPE OF EQUIPMENT FEE <br /> _ WATER CLOSET(TOILET) A/Cr-AIHNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M <br /> SHOWER I CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> _ DISHWASHER I pANOEHOFTD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> UR,NAL METAL FIREPLACE&CHIMN <br /> DRINKING FOUNTAIN I/ I FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP �— <br /> BACKFLOWPREVE ERS GAS PIPING <br /> _ ROOF DRAINS- INLEADERS I EXHAUST FA _ <br /> SINK(SERV) -BAR,ETC.) ; <br /> T <br /> 1 <br /> I <br /> T�- <br /> 10! <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ I PERMIT $ <br /> TOTAL FEE $ 1 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAR K ty PLAN CHECK FERECEIPT7LV � o � I fJO2VS/OT 4 4 7 <br /> � 4{ o1 Z <br /> USEZONE LOT AREA VACANT SITE FEE <br /> VALUATIO!'. FEE <br /> -Z SbO 'SQ.vt Yfs BUILDING I28 73 ;So <br /> TYPE 01 COWS ALLOWABH TYPE OF CONST ACTUAL ttfuNAh IKI p PM LlMi IAIHL - - <br /> c PLUM13ING <br /> SIZE OF BLDG NO STORIES BASEMENT MECHANICAL T <br /> 1145ff + 2 <br /> gliel 6F + - - <br /> OCCUPANCYlOAU FIRE SPRNKLERS REDO I HEKTH IMITATYJN ADDITIONAL PLAN CHECK Cr <br /> c� <br /> N 0 OTHER i <br /> REASON FOR SPRINKLERS 1 <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PI IBLIC WORKS I <br /> LOCAL SALES r' <br /> { TAX CODE IS 3105 TOTAL C J <br />