Laserfiche WebLink
APPLICATION FOR <br />vMnoI <br />CA EOF <br />CONSTRUCTION <br />everett <br />PERMIT <br />TO BE COMPLETED IN BLACK INK— PLEASE PRINT <br />BUILDING DEPT. <br />259-8745 <br />❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING CK SIGN <br />uwnL LAwnAooZIP PHONE <br />3/lL lfiLc Apt . F_i�na^rr <br />CITY ZIP <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE I, <br />ff!�RRL/ NeyN TNT. P,o, Bck 5--?-69 LY/vuw000 9Roy6 776-435- Bc22yAj*,;217L0 <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE A <br />CLASS OF WORK <br />I* NEW Cl ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />jALUATIONOF WORK (COST OF MATERIALS PLUS LABOR) <br />{.2Son..v <br />DESGHIBL WUHK <br />7A4r#L4 e'0 .'r9 `X38' S/�_ t/GN i —ALL PLY woo 0 /UAN 1 LL4MIA/R%t-'19 <br />USE OF BUILDING <br />AA _�C <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN 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 />SIGNAT R OF CONTRACTOR OR HORIZED AGENT DATE <br />X �1. <br />LEGAL DESCRIPTION OF PROPEPTYISHOWN BELOW OR ATTACH FOUR COPILSI <br />LOT_BLOCK­ OF <br />3 Iz <br />_ <br />PROJECT ADDRECR <br />APPLICANTS CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />I TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FED <br />WATER CLOSET(TOILET) <br />AIR COND. UNITS—H. P. EA, <br />BATHTUB <br />REFRIGERATION UNITS—H. P. EA, <br />IAVATORY(WASH BASIN) <br />BOILER&-H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA. <br />_ <br />KITCHEN SINK A DISP. <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />_ <br />DRINKING FOUNTAIN <br />NANGE HOOD <br />1 <br />FLOOR DRAIN <br />_ <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />ISTOVE <br />_ <br />ROOF DRAINS—RAINLEADERS <br />I METAL FIREPLACE A CHIMNEY <br />_ <br />SINK SERVICE —BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL f <br />__ <br />PERMIT f{- <br />PERMIT f <br />_ <br />TOTALFEE it <br />TOTALFEE f <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />FRONT SETBACK REAR SE TRACK SIDE SETB,,CK PLAN CHECK NUMBER FEE PLANT RECEIPT PT E <br />FRONT SETBACK 7� <br />ZONE ILOi AREA VACANT SITE - <br />FEES <br />DYES ONO <br />OFCONST I OCCUPANCY GROUP I NO. OF DWELLING UNITS <br />BUILDING <br />OF SLOG NO. OF STORIES MAX. OCC LOAD <br />P.UMBING <br />MECHANICAL <br />SPRINKLERS REQUIRED ❑ YES ❑ NO <br />OTHER <br />PENALTY <br />ICATION ACC BY PLANSCHECKED BY APPR. FOR ISSUANCE BY <br />TOTAL <br />S <br />VALUATION I FEE <br />