Laserfiche WebLink
APPLICATIO�°�"FOR CONSTRUCTI"�1 PERMIT � <br /> • TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: j�l GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> '7 DEMOLITION ❑ COMBINATION ❑ BUILDING f:l MECHANICAL `fi PLUMBING C1 SIGN <br /> OWN Q� / SC�LAODR[SS�I� dTY ZIP PHONE <br /> (�1%Y%1X%% Q'O--C <br /> *�NANT MAIIA�DHE55 CITY ZIP P110NE <br /> AR:MITECTORDESIGNER MAILADDNESS CITI 21P PHONE <br /> GENEBRLCONTRACTON MAILADORE55 C�TY ZIP PHONE STATEUGENSEt <br /> NECHANIU�LCONTRACTOR MAILADDRE55 CITY ZIP PMONE SiATELICEN5El1 <br /> PLUM INGCO FA OR MRILAy�SS - QTV ZIP PHONE STATELICENSE� <br /> Jr� �P.�v�t� <br /> CONTRALi PRIGE OF WORN <br /> OESCAIBE WORK ANU SOURFE FODTRGE INVOLVED CONTACT PE850N AND PHONE N0. <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PFOPOSEUUSE 60UILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF ' <br /> IEGRL0E5CN�PTIONOFPPOPENTYISNOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOi. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK oF AU7HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEP STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFh7ANCE 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 /> vnace�rnx i o.Nun+eEr+ . CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENOEP.AODRESS,iELEPNONE NlIMOER <br /> PROJEC}e DRESS sr.rwruae o"'� <br /> ��� C1.. c�irousiuc5suc[NSF NO <br /> �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX RE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEO AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESORYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER � RANGE H000 ' <br /> LAUNDRYTRAY � WATER HEATER ' <br /> � <br /> CLOTHES WASHEP � WOOD STOVE � <br /> URINAI ' METAL FIREPIACE(WOOD BURNING) � <br /> DRINKING FOUNTA�N � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKPLOW PREVE�lTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK VICE—BAR,ETC.) � , <br /> � <br /> i <br /> • SUB TOTAL 5 / i-7n SUB TOTAL $ <br /> PERMIT $ �—�� PERMIT $ _ <br /> TOTAL FEE $ /' 'O D TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK FEARSEiBACK SIDESETOALK PLANCH@CN�9�f1� FEE REGEIPTNO. <br /> ✓U <br /> USEZONE LOTAREA VAGANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ No BUILDING � <br /> 1YPEOiCON57. NO.OFSTONIES OCCuo�Ntr NaawrtluHGux:is ' <br /> GR0°^ PLUMOING � <br /> SREOFBLDG. FIRESPRINKLEHSRE00 BASEMENT MECHANICAL <br /> ❑ YES 17 NO ' <br /> ADDITIONAI PLAN CHECK � <br /> OGCUPANCYIJ�D FIREALARMREOU HEIGMTLIMITATION — <br /> i <br /> O7HEti �_ <br /> REASON � <br /> STATE OUILDING SURCHA(iGE ' <br /> i <br /> INTRI(E B� PLANS APPROVE�OY CIT�OF EVERETT PUBLIC WORKS <br /> LOCAL SALES � <br /> oAtE TAX CODE IS 3105 rorn� ' <br />