Laserfiche WebLink
APPLICATION FOR CONSTRUC7 .ON PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br /> BUILDING DEPARTMENT � HEATING SYSTEM: i„j GAS ❑ELECTRIi: ❑ <br /> 259-8810 <br /> .-BEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING <br /> � MAILAD ESS ��n. Z�P SIGN <br /> N N � �� PHpNE <br /> � � -� MlL�S�� �/��� 9�� �c 25Z �1�48,0 <br /> � � IOl✓� `':� �•'. ��/u+ I Z PMONE / <br /> wARCMITEGTOfiDESIGNER QIpILADDRESS �/ SJ � �! w"J�.�. ��D3 � <br /> ��N Z�P PHONE <br /> GEN CONTRACTOP MRILqDDRESS ��n. <br /> Z�P PMONE STATELICENSE� <br /> _ C2�M�' 2� <br /> MECHANILALCONTR�CTOP M�ILADDRESS CITV p�p <br /> PNONE STATE LICENSE Y <br /> PWMBINGCONTRACTOR MAILADDRESS �ITY <br /> Z�P PNONE STAiELICENS[R <br /> CLASS OF V/pRK <br /> NEW . ' ADDITION ALTERATION REPAIR . DEMOLITION ' � WOODSTOVE/FRPL INSERT BUILDING Rc'LOCA710N <br /> CONTACT PERSON AND PMONE N0. <br /> (/GONTqpCTPRICEOFWORK QQO � <br /> ���+� A�FOO GE INVOLVED <br /> /�G�- � S/�Lri_ <br /> 2L�C� <br /> Pr+o ouse Fem�oiNc � i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> � Z�� � � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG4LbESCRIPTIONOFPROPERTV�SH�SWNBELOWORATfALHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ior BLOCK pF WORK WILL BE COMPLETED WITH WHE7HER 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 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPE9TY TO PERFORM THE WOPK FOR WHICH <br /> APPLICATION IS IdADE AND I COh9PLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> PRQIECTADDRES$ o X�`1 3 �� i" �si� I <br /> �C�'� �c? <br /> / ��d �r.J scya-ac � onrc � <br /> mrv n•,iswrss ucr.�sE Ho <br /> PLUMBING MECHANICAL ' <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TVPE OF E�UIPMENT I <br /> WATER CLOSET(TOILET) ,s- �- FEE <br /> A/C—A'HNDLG UNITS—H.P. <br /> BATH7UB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) S�— UNIT HEATERS—B.LU. M I <br /> SHOWER � CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISH WASHER RANGE HOOD <br /> _ LAUNDRVTRAV ; WATERHEATER <br /> _ CLOTHES WASHER � WOODSTOVE <br /> _ URINAL METAL FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> _ DACKFLOW PREVENTERS ; GAS PIPING <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN — <br /> SINK(SERVICE—BAR,ETG.) � — <br /> � <br /> � <br /> � <br /> � - <br /> 3U8 TOTAL $ —'— SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ ' <br /> TOTAL FEE $ — TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBAGK SIDESEiBACK P�ANCHECKNUMBER FEf" FECEIPTNU. <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> 7YPEOiCON75.AlLONABLE TYPEOfWK51.ACTUAI atuoeryp xa.dpWnuH6UHrt5 BUILOING L/^�� <br /> �l <br /> cxouv � PLUMBING ' 1 <br /> SIZE OF dLDG. NO.OF STORIES BASEMENT /���/ <br /> MECHANICAL <br /> i <br /> OCCUPANCY LOAO FIqE SPRNKLEflS PEO'D HGIGHT LlMITAiION ADDITIONAL PLAN CHECK i <br /> i <br /> REA$pN FOq SPRINKLEPS SFFINKLER <br /> __ �_ <br /> STATE BUILDING SURCHARGE ��� <br /> INiANEBY PLANSAPPROVED6V CITYOFEVERETT PUBLI��WORKS � <br /> LOCALSALES � <br /> TAk CODE IS 3105 TOTAI. � � <br /> _ �, <br />