Laserfiche WebLink
APPLICATIQ�I FOR CONSTRUCT'-)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> 259-8810 <br /> I ❑ DEMOLITION ❑ COMBINATION �'BUILDING ❑MECHANICAL ❑PIUMBING ❑ SIGN <br /> O MAILADORE55 �ITV ZIP PNONE <br /> a8 >�.��������z�d. lv�4��a6=� 35.3� a ��� <br /> - TEN T MAILADDR SS CITY ZIP � PHONE � <br /> ARCHITECTORDESIGNEfl MAILADDRESS CI7V ZIP PHONE <br /> � GENE ACTOnR � 1 MAILADDRESS CITY ZIP PHONE STATELICENSE• <br /> �V(.� <br /> ' MECHANICALCONTMCTOH MAILADDRE55 CITY ZIP PHONE STATELICENSEI <br /> � PLUMBMIGCONTMCTOR MAILADDRE55 CITY ZIP PHONE STATELICENSEM <br /> � CONTMCT PflICE OF WORN � h/� <br /> ✓ 4 , <br /> � � BE K AN_D'SO E FOOTRGE INVOLV �J CONTACT PERSON AND PHONE NO. <br /> �/ <br /> � <br /> I I <br /> � i HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS �. <br /> � PROP0.5ED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT.ALL <br /> i PROVISIONS OF U1WS AND ORDINANCES GOVERNING THIS iVPE OF <br /> lEOALDESCRIPTIbNOFPROPERTV�SNOWNBELOWORATfACH7WOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE � <br /> ' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BV THE ' <br /> � OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH . <br /> I PARCELTA%I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE �, <br /> � CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> I CON5TRUCTION LOAN LENUEH,RDDHESS.TELEPHONE NUMBER ' <br /> PfiQ1ECT ADDRE *ur+e o�te <br /> crtreusmEssiweis no. � <br /> pLUM81N(i MECHANICAL , <br /> NO. TYPE OF flXTUAE OR lTEM PEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/�A/HNDLG UNITS—H.P. � � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UIVATORY!WASH BASIN) i UiJIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � <br /> - KITCHEN SINK 6 DISP � VENTILATION FAN ; <br /> - DISHWASHER � RAN6E HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � � <br /> � DRINKING FOUNTAIN I FIREPLACE INSERT � . � <br /> ' FLOOR DRAIN � HEAT PUMP � <br /> IBACKFLOW PREVENTERS ; GAS PIPING ; �. , <br /> RpOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> . _ I SINK(SERVICE—BAR,ETC.) ; ' _ , <br /> � <br /> ! � � <br /> � i -. <br /> � <br /> '� ' <br /> i � <br /> � SUB TOTAL $ ; SU8 TOTAL $ ' <br /> � PERMIT $ � PERMiT $ � <br /> j TOTALFEE $ ' TOTALFEE $ ' <br /> � FOR OFFICE USE ONLY: <br /> i FRONTSEiBACK NEARSEi&1CK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> I <br /> '� USEZONE LOTRPEA VACRNTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> � 'IVPE OF CONSi. NO.OF STOflIES occuPiwcv No.of owElunG UNrtS i ' <br /> Gxouv PLUMBING i <br /> � SIZEOFBLDC. FIRESPRINKlER5RE0'D BRSEMENT MECHANICAL � <br /> ❑ YES ❑ NO � — <br /> OCCUPANCY LOAO FIRE r1LARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> OTHEFi � <br /> REASON <br /> , STATE BUILDING SURCHARGE i�U <br /> � <br /> � IMAKEBY PLANSAPPFOVEDBV CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 T�TA� 7 ;,�Q <br />