Laserfiche WebLink
APPLICATIC- : FOR CONSTRUCT'1N PERMIT <br />fpo /Loo !Al.� Jam TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS J ELECTRIC -1 <br />259-8810 <br />DEMOLITION COMBINATION 11 BUILDING k MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS /I CITY ZIP n�UrvL <br />ARCHITECT OR <br />ADDRESS CITY ZIP PHONE <br />rnurvt <br />G NERAj <br />MAI BESS <br />CITY <br />ZIP <br />rnurvt al um LILtry oL •+ <br />jON nACTOF � 5T <br />NN LC f� I <br />;e't <br />, 5 EDHoues <br />950zo <br />503-0138 <br />MECHANICAL CONTRACTOR <br />&G <br />MAIL ADDRESS <br />/Nc l►c) <br />CITY <br />sAf?P/J <br />ZIP <br />ggf53' <br />PHONE STATE LICtNSE <br />305314 491PY540osels <br />PLUMBING CONTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTA�JSON AND P1n1_O D ,>)(P'� 7U y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING COISTRUCTION 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 />CANT C QRS IlW I G.27 RCW AND 296.200 WAC. <br />1II`�6-GI l <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK of <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECT AOD_WS s L <br />Q <br />CIC In 'I <br />RMe <br />CITY ROSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-A,HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />- <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />— <br />SUBTOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />rvn vrrwr_ v.+r <br />vl.�.. <br />SIDE SETBACK <br />PLANtCHECKUMBER <br />FEE <br />RECEIPT N00 <br />FRONT SETBACK <br />REAR SETBACK <br />USE 20NE <br />LOT AREA <br />VACANT SITE <br />ES <br />VALUATION <br />FEE <br />BUILTYPE <br />❑ YES O NO <br />DF CONST. <br />NOOF STORIES <br />=UMNCY <br />MR ffMLLIWMITSGRWPPLU <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED D <br />BASEMENT <br />MECHANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM AEG D <br />HEIGHT LIMITATION <br />I <br />OTHER <br />i <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />JM <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />DATE �Li <br />