Laserfiche WebLink
APPLICATIQ 1 �OR CONSTRUCT: )N PERMIT �✓� <br />TO BE COMpLETED IN BLACK INK—PLEASE PRINT <br />CHEATING SYSTEM � GAS U ELECTRIC U ] <br />BUILDING DEPARTMENT -- � — ------- _ <br />259-8810 <br />i DEMOLITION I COMBINATION <br />ow�rA ^ ue�innnn�ss <br />}C BUILDING ' MECHANICAL I! PLUMBING I i SIGN <br />piV ZIP PNONf <br />iENANI AIAIL�D�RfSS CIiY ZiP PHONE <br />RFCHIi1:CtORDE5IGNER IAPtLR�ONE�S Cliv ZIP pNONE <br />.�iu�zte���_Q�s,'p., adig�,/,��r.i/e .FiinN 9J�-o/ _zSz-r�zon -- <br />GENE AIGONTRr1Ci0F M�ILqDDN[SS CItY 2iP PIIONE STAIELILENSE� <br />C'cc�/ �/,f /39n/ /� •n�mncl /It', �I.�IICIPEI� �%Sn/z 335-/�G�� {�6�t�,[iS3J?_.-- <br />QECNqWCAICONiRACTOH AInLLA0�RE55 CI1V TiP PHONE ST/SELICENSE/ <br />PWM9iNGGONiRACTOP MBILACLqE55 CITV IIP PNONE SiF'EUCENSF� <br />���y�r+ll��,�,�(_33i� -SK:;;A�LE An/i���fe��r Sa:_3 �L3r-.sSSS <br />CONiRACi VRICE OF WORY <br />DESCRIBE WORK �ND SOU�RE �OOTRGE INVOLVFD <br />OF BWLUiNG <br />IEGPL DESCflIPTION OF PFOFERTY �SIIOWN BELOW OR <br />ior Z Aioc� -- ov — <br />P4RCELTA%ID NUMBER <br />GONSTRUGTIONLO�NLFNUER.AOORESS, <br />N0. TYPE OF FIXTURE OR ITEM <br />' � WATER CLOSET (TOILET) <br />i BATHTUB <br />KITCHEN SINK 8 DISP <br />DI3HWASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN'� <br />SINK (SERVICE—BAR, <br />CONTACTPERSON <br />i HEFEBY CERTIfY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL <br />_ PROVISIONS OF LAWS AND UHDINANCFS GOVERNING TRIS TVPE OF <br />:HnvocoP�esi WORK WILL BE COMPLETCD WITH WHETHEf; SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />' � AUTHORITY TO VIOLATE OR CANChL THE PROVISIONS OF �'rv <br />Q OTHER STATE OR LOCAL LAW REGULATING CONS7 RUCTION OR THL- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THF <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iE,�7 RCW AND 296200 WAC. <br />R <br />o -J x �°�L�lJ''C�l.�. —2 ��',-� <br />��3 s�r.v��uwi wrc <br />caro�sir�rssuccr+sr ao � <br />MECHANICAL <br />SUB TOTAI. $ <br />PERMIT $ <br />TOTAL FE[ $ <br />FOR OFFICE USE ONLY: <br />FqONT5E12RCK FEAR SETBACK <br />Z <br />USE ZONE lOT AREA <br />7 , �� Z� <br />iVPkOiLON57 NO OFSTORIES <br />� � <br />SIZE OF Ol Fl9E SPPINNlERS REOD <br />17i� S �" <br />S�f Sf � K <br />OGGUPANCY I UAD PIFE ALRFM REOD <br />INipN[ �V <br />nnie <br />FEE NO. TYPE OF EOUIPMENT FEE <br />A'C—A'HNDLG UNITS—H.P. <br />/ FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />/ CLOTHES DRYERS <br />,�1y VENTILATION FAN <br />qANGE HOOD T <br />WAIt? HEATER <br />WOOD ST(�:'c <br />. METAL FIREPLACF IWOOD BURN�NGI � <br />HEAT PUMP i <br />GAS PIPiilG ' <br />EXHAUSTFAN —� <br />0 <br />SI�ESETpACN PIANCNECKNUMGER <br />'z'� SH�P �-lI3a�7 <br />VACr1NT SITE FEES <br />:f' YES . � NO yUILDING <br />IXL�C�KY 5�10!ON(lli'.�:�H�I$ ' <br />�}°0L�— I PLUMBING <br />.� <br />onSEMENT � IdECHANICAL <br />'�.�! YES VNO <br />Htlmrt iMIiATiori ADDITIONALPLANCHECK <br />��_ O7HER <br />STATE Bl11LOMG SURCHAFGE <br />CIiY OF EVERETT PIIBLIC WORKS <br />LOCALSALES <br />TAX C�UE IS 3105 TOTAL <br />T <br />SUBTOTAL 5 <br />PEFMIT $ <br />TOTAL FEE 5 ' <br />FEE �F.�E iN0 <br />30 7i �7 <br />VALUATIJN FEE <br />%Z <br />7� � � <br />�f �� � � <br />� <br />i <br />� <br />