Laserfiche WebLink
APPLICATIC 1 FOR CONSTRUCT )N PERMIT 4 IT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM od GAS U ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />1 1 DEMOLITION COMBINATION I I BUILDING n1MEC/H�(ANNIC�AL i PLUMBING/ I SIGN <br />.O. IIIRI II ...1 w 11l .' rr—AIL ADDRESS ) AAQ i�, �CI Y'. �'I�1CY.� 7Yil/)HONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MECHANICAL CONTRACTOR MAILADDRESS, CRY ZIP PHONE STATE LICENSE IT <br />MAII. ADDRESS <br />CONTRACT PCICE OF WORK t� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRnT•CSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK COMPLETEDL BE WITH WHETHER FIED HEREIN IV <br />LGRA <br />ATTACH 7VI0 COPIES! <br />LEGAL DESCRIPTION OF PROPERTY SHOWN BELOW OR <br />ESUME TO GIVE <br />NOT THE TANG OF AERMITDOES NOT PRESUME <br />BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT <br />OTHER STATE OR LOCAL LAW REGULATING 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 LAW 18.27 RCW AND 296.200 WAC. <br />PARCE TA% I D NUM`'B�ERR <br />/�� <br />CONSTRUCTION GAINS A4 EL�M BUR <br />— <br />saN.TURF wtL <br />PROJECT ADDRESS <br />CITY aus"Oss I KFMV:w <br />MECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM FEE <br />NO• ENT <br />TYPE ONO. <br />FEE <br />AC -AIR DLG NF SOUH.p <br />WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />, <br />BATHTUB <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />' <br />SHOWER <br />VENTILATION FAN <br />' <br />KITCHEN SINK 8 DISP I <br />, <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />- <br />' <br />CLOTHES WASHER <br />, <br />' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />URINAL <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />, <br />FLOOR DRAIN <br />1 <br />' <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />' <br />---� <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />1 <br />, <br />EXHAUST FAN <br />' <br />' <br />T <br />, <br />I <br />1 <br />i <br />1 <br />SUB TOTAL S <br />I <br />SUB TOTAL b <br />PERMIT <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE S <br />cno nFFIrF IISE ONLY: <br />FRONT SETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />LOT AREA <br />VACANT SITE <br />USE ZONE <br />❑ YES 0 NO <br />TYPE OF CONST <br />NO OF STORIES <br />a <br />Ip aavrtuaOl.Nue <br />SIZE OF BLDG <br />FIRE SPRINKLERS REO'0 <br />BASEMENT <br />❑ YES ❑ NO <br />OCCUPANCYLOAD <br />FIREALARMREOD <br />HEIGHT LIMITATION <br />REASON <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />DATE <br />NUMBER III RECEIPTNO <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />b <br />