Laserfiche WebLink
APPLICATIC��� F�11� CONSTRUCT `��V! PEl�MIT � <br /> TO BE COMPLETED iN BIACK INK—PLEASE PRINT <br /> r ----- <br /> I HEATING:YSTEM: GAS i.J ELEC�RIC I_1 _____ ____ ] <br /> BUILOING DEPARTMENT --------- - <br /> 259 fi010 <br /> I I DEMOLITIOPI I I COMBINATION i ! BUILDING i MECHANICAL PLUMBING ; SIGN <br /> owr:E� ` / /n � rnnanooness crtr / zir y� nHUNe �7 - <br /> Ci��Y I �1/ V �I CL�17.�,�j I�i u��M.UTl7f) I�� IS)7�' P�I��� }S�_'�G7�"_.- <br /> TENANi MAILAp�RE55 CiLY ZIP PHONE <br /> �I .2�IYL C-��'a�f/i'i�nJ /k?Y�.1�f�'1r11 i' � ,.=—SE?�� I6r�ss -t����/e 3 <br /> RRCMIiEI:T VF OE51(iNER MML AODRESS CI1V _il' PMONE <br /> �oC/iU c��rUS%. 1/�l� i'D, dvxp'� //�4.�'.f��i!� �,C�"5� 35 3•- ?��71n i1'•�l/�t�.-+V-/loli�tF. <br /> fENEFAILUNTRRCTOR MFI: n00RE55 GiV 11P PMONE SiRTELICENSE� <br /> �FG• il.'�� �n�i,-.�� ;;./�/_��"�sf sw. � ' �% 9��oS �Yo/5��� iIFcNEivn`./`fE�� <br /> UECNRN�CAL GONTRpCTOP M�iL AOURESS CiTV ZIP PIIONE STRTE UCENSE• <br /> �i/F/?SSG'/LGC /�lt/Y�l/�2/R S.�'•��� ^�'�i��,.A 9s �� N�s�ss i�l/�+C.'y�SP//a!T/� <br /> PWAIBI CONiR�CiOR MAILA�ORE55 CI1Y ZIP VHONE STREUCENSEI <br /> �;i,7.S�».Cb /�S�i '� //L�//li� _.- <br /> [OkTRRCT PRICE OF WORK <br /> S/r1I�[F rigivil <br /> OESCNIBE WOPN ANO SOUME FOO AGE PIVMVED — CONTRC7 PERSON RND PHONE NO�,�� �Z oLm) 35 3 —�o�[� <br /> _ i HEREBV CERTIFY THAT 1 HAVF READ AND EXAMINED THIS <br /> YFOPOG:U USE W BUILOING AppLICA710N AND KNOW THE SAME i0 OE TRUE AND CORRECT.ALL <br /> _'�p�.�C��n,�:�� �/,J_F�c iiv6 PRDVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> lEOA_ .CS NIPfI)NOFPPOPEPTV15110 'Nf:LOWOFATTACNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �,(�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i.nT�-�a-�f-�� BtocK - oF AUTHONITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANV <br /> L�S �s 5 OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION UN THE <br /> - � - -Q -�i�;� PE-RFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> _ '�'-l�' C�OE�`�17I_���__ OWNER OF THIS PROPERTV TO PEqFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TH[ SiATE <br /> PAqCEL TA%1 D NUA�B[F CONTRACTORS LAW 18.27 RCW ANU 196.200 WAC. <br /> _�dT. /�'u.ia/i-� rtv�iu �� <br /> CONSTFUCTIONLORNLEN�ER.AODRESS.TEIEPNONE NIIMBER <br /> y7 Jf X ��/35SG-I!Y)L7 A7)� � '..� � __'_ <br /> PflOJECT ADDR(E�Qy/S/�� y� J Ay\A , v ant ne�e p �_ <br /> JZ(/�� SS UVV�_ ✓L/ LIIVPIl5WC55lrLFN51NO � <br /> PLUMBING MECH�INICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E011iPfAGNT FEE <br /> WATER CLOSE�(TOILET) � � A�C-A'HNDLG UNITS-�H.P. <br /> 9ATFiTUO ' FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY�WASH BASiN) � UNIT HEATFRS-B.T.U. M <br /> -- T <br /> SHOWER v CLOTHES DRVERS <br /> KITCHFN SINK R DI3P - i VENTILATION FAN <br /> DISl�',YASHEF - � RANGEHOOD -�— <br /> LAUNI�RY 1 Rf�Y � WATER HEATER - <br /> CLOTHES WAFHER ! WOODSTOVE <br /> URINAL METAL FIREP�ACE(WOOD BURNING) .- i� <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> _ FLWR DRAIN _` HEAT PUMP ___ _ _ <br /> BACHFIOW PREVENTERS GAS PIPING ; <br /> � ROOF DAAINS-FiAINLEADERS —� E%HAUST FAN —T- <br /> SINK(SERVICE--OAR,ETC.) ' - - ��/ ' � <br /> - _- ----_ �- ' -- --- . _.._ _._-�-•— <br /> --'-- -- t7A� [!i ..£ P .'-..---- - �- - -'- <br /> - -----' --'r--' <br /> SUB TOTAL $ �:�� _ _SUB TOTA.L $ _ � ) i <br /> PERMIT 5 PERMiT $ <br /> TOTALFFE $ ' TOTALFEE $ <br /> FOp OFFICE USE ONLY: <br /> �NONtSEiBRCN PEARSETBRCN' � SIDFSCiPAfr. P',pNCnECNNUMB� FEE ✓ RE��� N�J <br /> I �r C'� <br /> � �� �� �� <br /> use �oTnaen VACRNT..IiF FEES VALUATION FEE <br /> �-1 �►r/t�. �5 No euaoinc ���0 -`�y/ � J:% <br /> „ <br /> �IVP[Ui LONSL NO OF�JqIES rti^.re4u Ta n�nHtum�:ux¢ — <br /> —� � i <br /> aWMBING �� � ; �i� <br /> � _1—_'/ —_ <br /> SiIFOFBIIXS r�RESPA NIEHSHEOU B4SEMENT �� MF.CHANICAL L�� � <br /> �. r� YE$ �' IVII —�__�_ <br /> CC�PANCV .Op� ����A R�M��REOD NBGNiLINIiATlO!` ADDITIONALPI.ANCHECN <br /> � 'iy�_ OIHER /r% �('(� <br /> 1IA50N �--_ -" -- <br /> STATE OUILDING SURCHARGE L� ' i <br /> intAM[Bv PUNS RP RO D BV CITY OF EVLRETT PUBIIC WORNS <br /> � I� LOCAL SALES <br /> o�re �'j ayj TAX CODE IS 3105 TOTAL �r ' � <br />