Laserfiche WebLink
the Evergreen <br />CITY Or <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />APPLICAd ION FOR CONSTRI►.:TION <br />PERMIT <br />TO BE COMPLETED IN INK — PLEASE PRINT <br />OWNER <br />MAIL AWUMLO <br />1-T <br />.•• <br />•••••••• <br />�.le�T L "N.9T <br />fI 'fr <br />= / ":: ' <br />/,7,),I,r <br />3� •9 4,6..2a <br />�e <br />A,�d , , <br />1 TENANT <br />MAIL ADDRESS <br />DIIY <br />PHONE <br />ARCHRECI OR DESIGNER <br />MAIL ADIIRE88 <br />CITY <br />!IP <br />P110XE <br />GENERAL <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE LICENSE <br />/CONTRACTOR <br />rl�%ear <br />(7WdR� <br />MECHANICALCONTRACTOR <br />MAIL ADDRESS <br />G1Y <br />ZIP <br />PHONE IICENSEA <br />---ZIP <br />---P1gNE <br />I.INSE0 <br />PLUM&NGCONIRACTOR <br />MAIL ADOREI8_ <br />GTY <br />I CLASS OF WORK/ <br />❑ NEW 0 ADDITION ❑ <br />ALTERATION ❑ REPAIR <br />❑ DEMOLITION ❑ WOODSTOVE/FRPL INSERT ❑ <br />BUILDING RELOCATION <br />00 <br />c6aJj l <br />i ( <br />PROPOIEO UBE OP BUILDING r- �� <br />_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND <br />KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETED WITH <br />WHETHER SPECIFIEDHEREINOR NOT. THE GRANTING OFA PERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />288.200 WAC <br />SIGNATURE OF CONIRACTOR ON AUT110RIZED AGENT DATE <br />LEGAL DEBCRIPIION OF PIIOPERIYIBNOWN BELOW OR ATTACH FOURCOPIES) <br />LOi BLOCK OF <br />O ;L4 Y' ,'P r <br />PROJECT ADDRESS <br />APPLICANTS CITY ESS LICENSE AND INESS NI AE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — HP. <br />BATHTUB <br />FORCED AIR SYSTEMS — BTU. MEA_ <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS —BT.U. M__ <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE A CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SHOWER <br />KITCHEN SINK& DISP. <br />_ <br />DISHWASHER <br />_ <br />_ <br />LAUNDRYTRAY <br />- <br />_ <br />CLOTHESWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS — RAINLEADERS <br />_ <br />SINK ISERVICE-9AR ETC) <br />_ <br />SUBTOTAL & <br />SUBTOTAL & <br />PERMIT S <br />PERMIT & <br />_ <br />_ <br />TOTAL FEE S <br />I <br />TOTAL FEE & <br />FRONT SETBACK / <br />REAR SETBACK <br />SIDE�ET� K <br />Pl`NE CNUMQR) f <br />L' <br />FEN �- 12� <br />UREZONE <br />' <br />LOT AREA <br />'7 D&P <br />VAC.., FF,, <br />u YES NO <br />/owE`LIINO <br />FEEB <br />VALUATION <br />FEE <br />BUILDING <br />I G <br />LL <br />TYPE OF CONST <br />ALLOWABLE/ACIUAT-M <br />OCCUPANCY^GrROUP <br />M — / <br />NO OF UNIro <br />-V—_ <br />- <br />PLUMBING <br />_- <br />SIZE OF SLDO <br />s sF <br />No OF STORIES <br />BBMT <br />OCC LOAD <br />M4—c <br />MECHANICAL <br />OTHER'S _ 5 <br />S <br />TIRE SPRINKLERS REWIRED ❑YES O <br />NEKIHT LIMIIAIgN <br />/i71' <br />STATE BUILDING SURCHARGE <br />APPUCATON ACC BY PLANS AZ <br />/r <br />STATE ENERGY SURCHARGE <br />PUBLICWORKS <br />TOTAL <br />