Laserfiche WebLink
APPLICATIQ�' FOR C�INSTRUCTr'�►N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDINGDEPARTMENT � neHiirvti�v�itM: p$GA5 VELECTRIC ❑ I <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL � PLUMBING ❑ SIGN <br />OWNER MAILADDRESS CITV ZIP PHONE <br />`/�4�61� I}1�I;'ur)h��lz i c 1s�Y:lc f-�'�-�"'•�T `>�'.�c (, -'-i ? -)��� �, <br />TENANT M�ILAODRESS CITY 21P PHONE <br />ApCHITECTORDE5IGNER MRILADDRESS CITV 2IP PHONE <br />VGEnNE/RAL CIXJTRAC�TOR MAIL AD,�DPESS r1 qTV ( `-�^' STATE UCENSE � <br />� I�l: �� / / ( �. Lt'�'i' � JIC � �I � f 1.�7L�11�%t I �11�{ VL1"� ZIP �j.Fi� ( PMONE <br />Uon MAILADDRESS PMONE <br />�� � 7 ��ry Z�P STATEUCENSEI%-��4.[•�65�{1�/ <br />}�l.tC,-� S 1-��=K1't1NG- /". ^. •G'�\ 7 S �-%Zi�l�i1"1=1:r9(_l_S %.I'�; � �s'�- s' %��� ogOlz� <br />n � <br />PLUMBIN(3CONTR�CTOF MAILAODRE55 CITV I�p PHONE STATELICENSEM <br />C�NTRACT PpICE OF WORN <br />G(.n r�'— �. � C^ <br />DESCRIBE WORK AND SOUARE FOpTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br />''��/�l�-(�}� el �I�YLIJI.i�� �%��.i �%' r <br />�-572 hn — � o e n r <br />rno SEDUSEOFBUILDING <br />rnr- <br />�EGAL SCN�PT�ONOFPflOPEflTY�SH/�OW/N�B�ELOWORATfACHTWpCOPIES) <br />LOT?� }% �l� BLOCK �0 `I-� pF LL�Utii�7T�%� U� V <br />s'sl� <br />'ARCEI TAI( ID. NI <br />_�i C � . <br />—�:�-5'—G�e <br />..,.,.�..� ....�..�.� U�Lr-rF. s1%. <br />PLUMBINO <br />NO• TYPE OF flXTURE OR ITEM <br />WATER CLOSE7 (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHEF <br />UUNDRV TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />ROOF DHAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETCJ <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PEARSETBACK <br />USE 20NE <br />TYPE OF LONST. <br />SIZE OF BLDG. <br />OCCUPANCYLOAD <br />REASON <br />INTAKE BY <br />NO. OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIRE AIARM FEOD <br />PLANS APPPOVED BY <br />onTe <br />SIDE SETBACK <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A P P L I C A T I O N A N D K N O W T H E S A M E T O BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PpOVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION C�R THE <br />PERFORMANCE 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 />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />i/'� , <br />1x � . ,!��vl,� /� - 3- �/ y�- <br />TVPE OF <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—O.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOQD STOVE �1Q/ <br />M�TAL FIREPLACE ( D BURNING <br />FIREPLACE INSERT <br />HEATPUMP / <br />GAS PIPING d <br />EXHAUSTFAN <br />NUM6ER � FEE <br />❑ YES ❑ NO <br />BUILDING <br />UCCUVAHLY NO OfpHFLUHGUNPS � <br />G5q1P <br />PLUMBING <br />BASEMENT <br />❑ YES ❑ NO MECHANICAL <br />MEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />! OCAL SALES <br />TAl( CODE IS 3105 TOTAL <br />TOTAL FEE <br />Ej <br />a <br />i <br />i <br />i <br />=' <br />