Laserfiche WebLink
APPLICATIO"'"". �OR CONs�RUCT[""°+N PEFiMIT � <br />3 Zb�A � . TO 8E COMPLETED IN BLACK INK—PLEASE PRINT <br />��0�� �g�� <br />BUILDING GEPARTMENT HFATING SYSTEM: ] GAS U ELECTRIC ❑_ _ J <br />259•8810 �� <br />❑ DEMOI_ITION ❑ COMBINATION ❑ BUILDING ❑ iNECHANICAL Ll�PLUMBING ❑ SIGN <br />OWI�ER. n /� �/p�'-AD�FE55 _,., I QTV, �. ZIP/1 PHOW . . <br />T':NqNT � / // MAILADDRESS <br />/ 1!// //l � / / � <br />Lil\11./\VU�ICJi <br />� <br />1.!AIL ADDRL85 <br />GIIY <br />:TY <br />21P PHONE <br />ZIP PHJNE <br />� z. __ 597-735� <br />ZIP PHONE STPTE LICENSE k <br />�m m�anuoneaa q�.Y ZIP PHONE STATEUCENSEa <br />��1��.s�,ti_'L_�'f15 Z2^'0.3rNW f!ul�uzu iSml 8�4-4os3 su�v��ax i u�or� <br />PUJMBIf:GCON2RACTqfl VAILAOORESS CITV LP PNONE STATELICENSEa <br />CCkTRhCT?RICp. OF V: JRK <br />7ESCRIBE WORK AkD SOUARE FOOTAGE INVOLVED CONTACT PERSOM1 �ND PHONE NO. <br />PROPOSED 115E OF BUII UING <br />LEGAL UES�RIPTIO'J OF PROPERTV (SHOWN BELOW OR ARACH 7W0 COPIES) <br />LOT BLOGK OF <br />PFRCELTA%I.D.NUMBER <br />CONSTPUCTION LOAN LENOER, HD�FE55, TELEPHONE Nl1MBER <br />NO. TYPE OF PIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & QISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />/ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SUB TOTAL $ <br />PERMIT 3 <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK PEAR ScTBACK <br />USEZONE LOTAflEA <br />TVPE Of CONSi. NO.OF STORIES <br />SRE OF BLDG. FIRE SPRINKLERS REO'D <br />OCCUPANCYLCtD FIflEALARMflEa'0 <br />fIEA50N <br />BY PL�NSAPPROVEO�V <br />onre <br />I HEREBY CERTIFI' TFIAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K�JOW THE SAME TO BE TAUE ANQ CORRECT. ALL <br />PROVISIONS OF LAN'S AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMFLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM:� TO GIVE <br />AUTHORITY TO VIOLATE OR CANCE� THE PROVISIONS QF ANY <br />OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION UR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFK FUR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THG STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />_/ MECHANICAL <br />FEE N0. TYPE OF EdUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M <br />� UNIT HEATcRS—B.T.0 M1i <br />' CLOTHES DRYEFS <br />� VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER � <br />� WOOD STOVE T— <br />; METAL FIREPLACE (WOOD BU^NINC <br />� FIREPLACE INSF.RT <br />�— <br />_L_ HEAT PUMP _ <br />� GAS PIPING <br />SIOE SETOACK <br />VACANT SITE FEES <br />❑ YES ❑ h�� BUILOING <br />OC[JCAqCv NOCfOWfLLINGUN115 <br />cwoua PLUMBING <br />BASEMEN7 MECHANU;AL <br />❑ YES p No <br />HEIGHiLtlAITATION NDDI710NI�LPLANCHECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT r�UBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />PERMIT S <br />TOTAL FEE $ � <br />FEE RECEIPTNO. <br />�. <br />