Laserfiche WebLink
APPLICATIO�' FOR CONSTRUCTI'"N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDINC DEPARTMENT �HEATING SVSTEM: J GAS J ELECTFIC J __ _ � �� � <br /> �SQ.Co!J <br /> DEMOLITION COMBINATIO� xBUIL0ING MECHANICAL PLUMBING SIGN <br /> OWNER I,IqqApDRE55 C�iV 2iP PHONE <br /> ,C3oE�Ns �. P. o. �o�c 3� a� , �s o�--i3 Ss��rcE , wA • 4h°�L'f 3'1Z-7339 <br /> TRIA/NJi� �4�ApDRE55 Cliv � j�P GHONE <br /> X/L�/n/6 • <br /> •AGwiECi09pE5iGNER IAULA0��E55 CITV jln pNON[ <br /> �OE�nJE, . <br /> OENER4LCONiHnC�OH Aui�qODRE55 CITV jlP PNONC STATE uCENiE• <br /> !£✓�2��I5�,/ �'�O(3�(.. <br /> MECNANI�A��ONTR�CiOR Iui�qppqE55 GIiV zIP PNONE STNTEIICEN'fE1 <br /> IPLUMO�NGCONTR4f.tOR i,�Ai��D'JRE55 �itv Z�P P��ONE Si�iELiCENSE� <br /> CONiPACiPR�CFO�WORK /, �/ �q — <br /> �� <br /> DCSCRiOE WO�iR pNO50UAllC�OO1nGE�NVOLV[D C041nC1 PLIISON M�0 i���ON[110 — <br /> �Q6c.oc,{-r� TR.�rc.sti � Q-It�rNGcr� Lsonr.�n,,� fjSTEA.� i3o2ski 266•-3SG� <br /> o�t-�[,f1N5%2UC'j L�IVT� (�GC-K- i HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THiS <br /> raoaoseo u;F or nmpir�c APPLICAiION AND KNOW THE SAME TO BE TRUE AND COtiRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TVPE OF <br /> �ecninescamno��c�o,.oeEarv;s��o•:n�ee�owOanrrewrwucoPies� WORK WILL BE COMPLETED WITH WHETHER SAECIFIED HEREIN OR <br /> ior e�ocn pr NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITV TO VIOLATE OR CANCEI THE PqOV1510NS OF ANY <br /> _ OTHER STATE OR LOCAL lAW REGULATING CONST9UCTION OR THE <br /> PERFORI,IANCE OF CONSTRIICTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> P�AGEL fR%ID N�IA�BEP APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRA//C��TORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSinURi04L04NlENDEA �DCRE55 TEIEPHONE NUMBEF �, / / <br /> PROJECT ADD ESS /n �,,,— � "��� �� /9�- <br /> 3�� ���N� ��' �� _� �✓ Ci1rpV5iN[SSIiCFN51N� <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF F�XTURE OR ITEM FEE N0. TYPE OF EOU���MENT FEE <br /> _ WATER CIOSET(TOILET) A�C-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCEDAIRSVSTEMS-B.TU. M EA. <br /> LAVATOHY(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER CIOTHES DRVERS <br /> KITCHEN$INK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> _ DRINi(ING FOUNTAIN FIREPLACE INSERT � <br /> __ FLOOR DRAIN HEAT PUMP <br /> . ' _ . _—___.--__—___-- ' .____ _ .__—_--__—.- . <br /> f3ACKPLOWPREVENTERS '---�--" -����-�--- �' <br /> GAS PIPING <br /> ROOF DRAINS-RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE-BAR,ETC.) <br /> SUB TUTAL 5 SUB TOTAL E <br /> _ PERMIT E PERMIT $ <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> iRONiSETBRCN REAqSETBACN SIDESETB�CN PLANL��EC NUTApER FEE PECE�pTNO <br /> � � �7� <br /> use ior+e ior,ae� V�C�NT SiTE FEES VALUATION FEE <br /> . �. VES "-' NO BUIIDING <br /> Iro[Of�01�5t NOO'S10PoE5 nrti,nyn ymm�w(o.ar.nr,�is - . <br /> �,�,��r PLUMOING <br /> 54EOFBlOG RRESPRiNN�EASPEOD BpSEMENi MECHANICAL <br /> ' VES NO - <br /> OCCUP�NCYl0A0 GiPEA�eqrAREOU NEIGNT�iMiiAiION ADDITIONALPLANCMECN <br /> RE�SON OTHER <br /> _�_ <br /> STATE BUIL71NG Sl1RCHAFGE <br /> WiRNE 9v vu„s noPAoveo e. � CITY OF EVERETT PUBLIL WORKS <br /> LOCALSALES � <br /> o.re TAX CODE IS 3105 TOTAL —�—� I <br />