Laserfiche WebLink
APPLICATIOR�OR CONSTRUCTIC��1 PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �')GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> '�] DEMOUTION ❑ COMBINATION f l BUILDING I 1 MECHANICAL `t PLUMBING I I SIGN <br /> OWN ij� / S�LA�SS�I� C11Y 21P PHONE <br /> �%Xl1X%% <br /> TENANT MF�LADOFESS CITV ZIP PHONE <br /> ARCHITECiOR�ESIGNER MAIIRDDRE55 CITV 21P PHONE <br /> GENPP�ICONTRACTOR M�ILAUDRE55 CITv ZI PNONE STATELICENSE• <br /> ���j- �/2��� ' ��� �-�-��-/ - <br /> MECHANICAICONTFAGTOR MAILAO�RE55 CIiV ZIP 7XONE STRTELICENSEI <br /> PLVM INGC RA OH n MAILA�wn ' /J � ��Ty Z�P PMONE STA7ELICENSE� <br /> // - � '�c� �L �' D 13/IL <br /> X ..r�i QiC� <br /> GONTRAGT PRICE OF WORK � �� � �P�-- <br /> 3 5 � �., a <br /> DESCRIBE WORK AN�SOUpNE FOOTAGE INV EU CONTAGT PERSON AND PNONE NO. <br /> i HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> PNOPOSED USE ' UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CURRECT.ALl � <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCPIPiIONOFPPOPERTY�5110WN8ElOWORATTPCNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IME TO GIVE <br /> �or o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCiION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTNOR�ZED BY THE <br /> OWNER UF THIS PROPERTY TO PERF09M THE WORK FC9 WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRLEL iAX 10.NUMBEP CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,A�DRESS,TELEPNONE NUM9ER i/ ia�9.� <br /> X — <br /> PROJEC DRESS e sicN.*une �"" <br /> ��� �'�-' �� cnrnusirvcssuc�vscrva <br /> PLUMBING MECHANICAL <br /> ' NO. , TYPE OF fIX RE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 30 WATER CLOSET;TOILET) � A/C—A/HNDLG UNITS—H.P. __ <br /> OATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> Zg LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRVERS <br /> �J KITCHEN SINK 8 DISP � VENTILATION FAN _�_ <br /> DISHWASHEF RANGE HOOD ' <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE _T_ <br /> /0 URINAL ' METALF1�EPLACE�WOODBURNING) ' <br /> � DRINKING FOUNTA�N � � FIREPLACE INSERT � <br /> ZIj FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PFiEVENTERS ; GAS PIPING � <br /> 9 ROOF DRAINS—RAINLEADERS � EXHAI IST FAN ' <br /> � SINK VICE—BAR,ETC.) � � <br /> � --� <br /> � ' <br /> � � <br /> o�% � <br /> � ' <br /> SUB TOTAL $ '� I I �)�� SUB TOTAL $ ; <br /> — PERMIT $ JU �JJ PERMIT S �_ <br /> TOTAL FEE $ � l ' VU TCITAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSET'dAGK AEAiiSETBACK SIDESETB�CN PLANCHEC NU�.IBFQ^ FEE PEGEIPiNO. <br /> (�1y6� <br /> usezor+E LOTAREA V4CANTSITE FEES VALUATION FEE <br /> ❑ YES 17 NO pUILDING ' <br /> iYPEOiCONST. NO.OFSTORIES OC[uvex:r x0.�vnnuNcuxrtS � <br /> cnWv PWM�ING <br /> _ <br /> S�ZE Of BLOG. FIRE SPRINNLERS AEO'0 BASEMENT MECHANICAL <br /> ❑ ves n No ; <br /> OLCIIP�NC�LOAD FlRE AL�RM REO'0 HEIGMT LIMITATION <br /> ADDITIONAL PIAN CHECK <br /> t <br /> OTHEfi � <br /> �cA50N � <br /> STATE�UILDING SURCHARGE ' <br /> IN1Akh B� FL4NS�PPROVEUBV CITY OF EVERETT PUBIIC WORNS <br /> LOCRL SALES <br /> onTe TAX CODE IS 3105 TOTAL <br />