Laserfiche WebLink
APPLICATIC i FOR CONSTRUC7�JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HE�711�G SYSTEM: �GAS U ELECTRIC IJ_ ------� <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION �BUILDING'T 1, I i MECNANICAL I I PLUMBING I I SIGN <br /> OIYNER MNLAOURE55 CI1Y 71P PIIONE <br /> J DH G�ouP 27�1 WET►t0�� �/6 5.5eo EYfiRETs,WI� �182ot 38b�-8�a <br /> iENANT MNIAUDfiE55 CIIV Zm PNONE <br /> No�Z�lt�u Go. lbo5�Aul�hVE. �v�TT, 1,wE �i'$2q Zg�1.7R9b <br /> �RCN�.IECTORDESIGNER MAIL�DDfiE55 g�ty Z�p ryi0��� �� �n�� <br /> Jouf�7��K�w � To►uE� h.�• �TTcb,wx q�loi � <br /> GENER�LGOIJiR�C10R 61NL�DU�E55 ^ CItV ZIP PIION[ S7AlEUCENSEt <br /> ME��CALCOt��q 315GRES����y�� q1�����/���—��'�MONE�—�D1A�ICENSEY <br /> PWMBINCCO�IiR4CTOR AN�IpDDllE55 CIIV 21P PIIONB SiAtELICENSE� <br /> �r�n I r mc,e�n� -- <br /> 4 ��T� <br /> o�c�� ie�wo�r�o A�e����U�A�T ILIT'�ZO�IE' �ournctven�r�nr�orr�nNeNo <br /> �' <br /> NEut hr �c�sz 7, nAunxa- -p���1�,�1ot��'��r�u 2��•a2a3 <br /> i HEREBY CERTIFY THAT I I1AVE qEAD AND EXAMINED THIS <br /> PROPOSEDUSEOFOUIL�IryG APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> FbRT�tU OF P�-2 D�pIGE px,Lt' • PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �ecn�oelln��no��orraorEnrv25 ne�owon�nATD��v S�ZETr NOTTHELGRA T�ING OF A ERMITVDOC-SENOT PRfES MEETO GWE <br /> LOT�_ BLOCK Of 1 Ya� <br /> N�� Q rT AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> VVW�� 7 Or �`S� {�E 3Z OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORb1ANCE OF CONSTRUCT�ON.THAT I AM AUTHORIZED OY TH� <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> rnnc€�rnx o uMoen APPLICATION IS MADE AND 1 COMPLY WITH THE ST�TE <br /> `j� �'r����' ���� UONTRACTORS LAW B27 RCW AND 296200 WAC. <br /> cor+si nucTiorv�onN�erroen nooness.ieierHoriE NUMnen � <br /> � hTTKNH6l�T �'/�,' ' f 12•l�� <br /> PRO:ECT DDRESS sKN mne nstt <br /> DCof.PXAVE I,DOR'l F�'RTIh� �,,,a�=,„�ss„��„s�,,,, <br /> PLUM ING MECHANICAL <br /> NO. TYPF.OF F!XTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEfAS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-8.7.U. M � <br /> SHOW[R � CLOTHESDRYERS , <br /> _ KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> _ DISHWASHER RANGE HOOD � <br /> LAUNORY TRAY ; WqTER HEATEF � <br /> CLOTHES WASHEF _ � WOOG STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ��-- <br /> DRINKING FOUNTAIN ; FIFEPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKfLOW PREVENTERS ; GAS PIPING ' � <br /> ROOF DRAINS—RAINLEADERS �_ EXHAUST FAN —T— <br /> SINK(SERVICE—BAR,ETC.) � --�— <br /> � � <br /> . .---�— — � � <br /> � —�— <br /> � � <br /> � <br /> � <br /> . SUB TOTAL $ SU�TOT�I $ � <br /> PERMIT $ � PERMIT $ ; <br /> TOTALFEE $ ' ' TOTALFEE $ —�— <br /> FOR OFFICE USE ONLY: -�- �, <br /> FRONi 5E10�CK REAR SE704CK SIDE SETB�CN PLAN CNECK NUMBER FE� REC��p. � <br /> .-�C. C/1 <br /> usezoNe ioranen VAC�NTSIIE FEES VALUATION FEE <br /> f-1 YES ❑ NO OU�ID�NG �/��� <br /> 7YPEOiCON51. NO.OFSTORIES occure�Rr xoorowtuixruxitc �/�.7_ � ��� ��� <br /> � F� IZ— ���_ �' PLUM�ING ' <br /> i <br /> 512EOF�LUG. PIPESPRINXlERS1iE00 UASEMENi --�-- <br /> .r. ��'+y�j }�YES I I NO MECHANICAL ' <br /> i <br /> OCCUPANCYLOAD FIREALA)�RyI�APEOD NEIGHiLIMITNION ADOIIIOfJALPLANCNECK � <br /> TI• IG"7 OTHER ' <br /> � <br /> REASON1���,/ 7��-- <br /> �7�(I ��h� STAIEBUILDINGSURCHqfiGE f � � 1 <br /> / <br /> wrnHeer MnNsnarnovEoor CITYOFEVERETT PUBLICWORKS ; <br /> �M LOCAL SALES <br /> onie �y�� !t`/, TAX CDDE IS 3105 ioT�� �Z� �� <br />