Laserfiche WebLink
F'� <br /> 1 AWPLICATIQ`: FOR CONSTRUCT►�N PERMIT � '' <br /> �� 1 TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 1) <br /> � HEATING SYSTEM: U GAS ❑ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 � <br /> i ! DEMOLITION ' COMBINATION I BUILDING f I MECHANICAL I�pLUMBING i � SIGN � <br /> O\VNER IdKLAp�f1E55 CITY 2iP PHONE <br /> ���W u� �� �k ��„� _.�,�y r�,rti��� ��.�o� .�s a -y3G � <br /> IENANT AIAILADDRE55 GITY ZIP PNONE <br /> ARCHIT[CtOR0E5�GNER MAILA�DFESS CITY 21P PMONE £ �� ' ` <br /> i, <br /> 0 1 (� <br /> GEN[H��CONT(IACTOq MAILADDRESS CITY ZIP �MONE SiATELICENSEt .;�LY � �� <br /> � � <br /> � — :::t '�' ��I <br /> � �� , ' . ..:��. . . <br /> h�ECNANICALCONiRACiOR AIAILA�OR[55 CIiV ZiP PMONE STr1TElICENS[� !':., '} �.`�'';�,. <br /> •ri '.v_ .r <br /> � � � FLUMOiNGCONTfiACTOR MFILAD�RESS CITY 21P PNONE SiATEULENSE� <br /> � yy L�� 1S/�Iu � i/�i ! � U3�b / rf�?! S�u - �<l � 4�uu al�S S/Si7 <br /> � � � CONTBACTPPICEOFWORK � <br /> K n <br /> I-3 .� DESCFiBEWOFNANp50UAREF00TRGEINVO�VEO CONtACTPER50NANOPN04EN0. <br /> "��t""G- 'tl P� ��i nua O1� P/P.r--i.�(�-�r2� <br /> �y z � /n/ � , „ � _ c c /�!U S-f.QU � 2 • 3 7 L-� <br /> H C! i HEREBV CERTIFY THAT I HAVE READ AND EAAMINED THIS . <br /> � ~ �y PROPoSEDUSEOFBWLOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> � C�jJ O PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> H� � lEWL0E5GRIPT10NOFPROPERTV�5M0�YN0ELOWOFATTACMTWOCOilE51 WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> y �..� � NOT. THE GRANTING OF A PERMIT �OES MOT PRESUMF' TO GIVE <br /> 9 y tot BIOLK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOK i OF ANV <br /> � <br /> fy y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �y y H PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � d G� OWNER OF THIS PFOPERTY TO PERFORh1 THE WORK FOR WHICH i <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � � h� PnRCEL TA%1 D NUMOER CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> [�i� � "70 �7 - 00�/- oos"--. 000s— -� �, <br /> �W CONSiRUCiiONLOANLFNO[B.RODRESS.TELEPNONEIlUAIpEH <br /> PROJECT AODRESS ''�� �� o��� � <br /> � ���� � \ �/� : ,.-..r.s.;«<���ti:�:�.n <br /> PLUMBING MECHANICAL <br /> 1 - NO. TVPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> I �� ( WATER CLOSET�TOILETI _ _ A�C-0.�HNDLG UNITS—H.P. <br /> � BATHTUB FORCEO AIR SYSTEMS—B.T.U. Ai E.A. <br /> � ( LAVATORV(\VASH BASIN) UNIT HEATEFS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> . �� . KITCHEN SINK 8 DISP VENTILATION FAN � � <br /> j DISHWASHER RANGE HOOD � <br /> j LAUN�RY TRAY WAT[R HEATER , <br /> . CLOTHES WASHER WOOD STOVE ' <br /> UAINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> I �� FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPIN6 � <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> � SINK SERVICE—BAR,ETC.) ; <br /> �� n <br /> ��' SUB TOTAL 5 SUB TOTAL 5 i <br /> _ � PERMIT S Z�'' PERMIT S � <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FPONi SETBACK FEAR 5[TBALK SIpE SETpACN PLAN CMELN NUM1ICER FE[ AECEIPi NO I <br /> / %ii/i <br /> uSexoNe LOTAFER VACANTSITE FEES VALUATION FEE , � <br /> ❑ YES ❑ NO eUi�owG <br /> T'PEOFCONSi r10.OF5TORIES aCuowCr xOa�Dn4uxcusu5 i ' <br /> 4°aj° PLUM0ING <br /> SQEOFBIDG FIqESPFINRLERSNEOD eASEMENT MECHANICAL � <br /> � i i YES ❑ NO I <br /> OCLUPANCYLORD FIPENANMREO'D NEIGNTUTAITRTION AD�ITIONALPLANCHECK � I <br /> OTHER <br /> � � <br /> REASON —�— <br /> STAiE BUILDING SURCHARGE �� <br /> V:iAH[LiV PUNSAPPNOVEOBV CITYOFEVERETT PUBLICWORKS <br /> LOCALSALES <br /> onre TAX COUE IS 3105 TOTAL <br />