Laserfiche WebLink
APPLICATI�"`I FOR CONSTRUCT'�`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> C1 DEMOLITION ❑ COMBINATION ❑ BUILDING [7 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> pµ�p5p �^ MAILADORESS CITY ZIP PHONE <br /> / ��c��� �/.•.. ,,,,.1 �_, �.��! �b;�1�3 .�5.� S'%�l3 <br /> � t"�I!!l�/ 11U�'lI N 1/)l � L <br /> TE�ANT / � MAILADDRESS CITY ZIP PHONE <br /> AqCNITECTOR�ESIGNER MAILADORESS CIN ZIP PMONE <br /> GENER�LCONTRACTOR MAILADDRESS CITV 21P PNONE STATEIICENSER <br /> MECHANICALCONTRACTOFi MAILADDRE55 CITY ZIP F/ONE SfATELICENSE� <br /> PLUMBING LONTflACTOR MAIL AODflE55 CITV ZIP PNONE STATE LICENSE 1 <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE WORK AND SOUARE FCOTAGE INVOIVED CONTACT PERSON AND PHONE NO. <br /> � ��, ,�d - -i �s �- f � �Fd � <br /> n � � na ,�u,��c�' <br /> �(j GCIi'Q .(Je-. �1.xnr �( l S9 Y'�' _�I /�'`' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH1S <br /> rAoaoseo use oF ew�o - APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTIYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN�fING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK oF pUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> FARCELTA%I.D.NIIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSTRUCTIONIOANLENDER.A0DRE55.TELEPHONENUMBER , � <br /> �. . _ „ J ,�ocu�.� /i� j <br /> � <br /> PROJECTADDRESS � scr��ma- o^' <br /> . � d � ��..o�s��E==,��E�=E� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br />��'�' � � - B�THTUB ; FORCEDA�RSYSTFMS—B.T.U. M E.A. ' Jks� <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYEfiS ' <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN I <br /> � DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ` <br /> CLOTHES WASHER � WOOD STOVE _� <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINL'eADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAfl,ETC.) I � <br /> � ' <br /> � � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL 5 ' <br /> PERMIT S � PERMIT 5 <br /> TOTALFEE $ ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FflONT SE78ACM PEAR SETBACK SIDE SETBACK PLAN CNEGN NUM1IBER FEE �7ECEIPT NO. <br /> usezo�+e LOTAREA \'ALANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> IVPEOiCON51 NOAFSTOPIES occuoexcr xoorumwhcuxns � <br /> 4qp1P PLUMBING � <br /> SIZE OF BIDG. FIRE SPRINKLEPS REO'D BASEMENT MECHANICAL � <br /> , ��,. ❑ ves ❑ No � <br /> OCCUPANCV LOAD FIRE ALARM RF.O�O HEIGHT IIMITATION ADDITIONAL PLAN CHECK � <br /> OTHER i <br /> REnSON STATE BUILDING SURCHAFGE �! i [�/ <br /> INTAKEBY PLANSAPPPOVEDBY CITYOFEVERETT PUBLICWORKS i <br /> LOCAL SALES �— <br /> oATE TAX CODE IS 3105 rorn� ' <br />