Laserfiche WebLink
- APPLICATIC""7 FOR CONSTRUCT'�lN PERMIT � <br />TO BE CON:'rLeiED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATiNG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />259-8810 <br />O DEMOLITION ❑ COMBINATION Cl BUILDING ❑ MECHANICAL ❑ PLUMBING �SIGN <br />UWNER MAIL AD�RESS CITY ZIP PHONE <br />To P Foo Ds i C� �5 SE �'yE,er-rr /�//.a r. [. (�Gf 2� C� - � 55' ��='� / <br />TENANT MAILA�ORESS LITV ZIP PHONE <br />c.cs ��K ic�i9 � �, A„F � � a�c�- ��r��-�.a9� <br />APCHITECTOROESIGNER MAILADDRE55 CI 21P PHONE <br />��,,,ec.� a/d-r-.o��a�. �f=/�/� f�M•r�, oi ;c nauo o2oSs �3`sS-'�o20 <br />— <br />.�necr ��-: t <br />MECHANICALCONTflACTOR <br />PLUMBING CONTfif�CTOR <br />CONiflACi PflICE OF WORK <br />DESCRIBE WORK AND SOl1ARE <br />MAIL ADDRE55 <br />� //32�//hGi�:c� <br />MAIL AJ�RESS <br />MALAD�RESS <br />/2o a� <br />7A E INVOLVED <br />T s7-,� �. <br />/o s�J F'r T�'rR L, <br />PROPOSED USE OF BUILOING <br />LEGAL UESCRIPTIOY OF PflOPERTY (SMOWN BELOW OR ATTACH TWOCOPIES) <br />LOT BLOCN OF <br />PARGELTA%I.D.NIIMBEH <br />CONSTRUCTION LUAN LENDER, ADORE55, TELEPHONE NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP � <br />DISHWASHER <br />LAUNDRYTHAY <br />CLOTHES WASHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />� SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />PEFMIT $ <br />TOTAL FcE $ <br />FOR OFFICE USE ONLY: <br />FFONTSETBAC:< AEARSEiBACH <br />USE20NE LOTAFiEA <br />TVPEOFLONSL � NO.OFSTORIES <br />SIZE OF OLDG. FIRE SPRINNLEFiS REO'D <br />OCQIPANCYLOA� FIREALARMRE�'D <br />REASON <br />INTAKEBV VLANS I[FROVEDBV <br />cm • zia <br />Dt.✓y�`7 /�� <br />f.ITV ZIP <br />CITV ZIP <br />c G �i1%A <br />PH 3 S� � STATE LICENSE p <br />o���/ .SMPAC�/�d 7: <br />PHONE STATE LICENSE p <br />PHONE STATE UCENSE e <br />CONTACT PERSON AND PHONE NO. <br />3�5-oSZy <br />i HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION P.ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS nF 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 />AU'fHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 1�.27 RC� 296200 WAC. <br />(/ <br />]L l��Yl aC//Ua�t 5.2�--9`� <br />SiG��q10RE DATE <br />CIIY OUSINE55lIGENSL ND <br />MECHANICAL <br />d0. TVPE OF EOUIPMENT FEE <br />A/C—FVHNDLG UNITS—H.P. � <br />FOflCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT HEATERS—B.T.U. M � <br />CIOTHESORYERS � <br />VENTILATION FAN ; <br />RANGEHOOD � <br />WATER HEATER <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSEFT � <br />HEATPUMP � <br />GAS PIPING � <br />EXHAUSTFAN � <br />SUB TOTAL 5 <br />?ERMIT 5 <br />TOTAL FEE 5 <br />SIDESETBACH PIANCHEC(N M��R D FEE// //`/ <br />j p O � <br />vncnnrsrte FEES VALUA' <br />❑ YES ❑ N� BUILDING <br />oeaeexer xo.ovowewxeux��is — <br />enauv PLUMBWG <br />BASErAENT MECHANICAL <br />❑ YES ❑ NO <br />;iE1GHTLIh71To,TiON ADDIiIONALPLANCH[CK <br />_ OTHER <br />STA� 9 BUILDMG SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />U �.� � <br />_� <br />i <br />i <br />T <br />33 ; �Z� <br />