Laserfiche WebLink
APPLICATIfy''1 FOR CONSTRUCT"'yN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM ■GAS I]ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> CI DEMOLITION ! 1 COMBINATION / BUILDING ■ MECHANICAL � PLUMBING ❑ SIGN <br /> p1YNER MAILAD�RESS CITY ZIP PHONE <br /> �nS Ko�N�� �/S'/3 c.+��`r� o C c-ictrlf 9 Zo (zc�(, 252- Y9�13 <br /> TCIlANT �IAILAODRE55 CITV ZIP PNONE <br /> ¢•� • � a�:. n1 -G o�l.F'.Av� ��Uz�7T ' dl (zoc) 25Z - `�ZvD <br /> ARCHITE TORDESIGNER 6�ni�ADDPE55 <br /> CITY ZIP PNONE <br /> owN� 2 <br /> GENER�L GONTFAC70R MAIL AODRESS CITV 2iP PHONE STATE LICENSE i <br /> �lh.�►.�l,:(Z <br /> h1ECMANICALCONTRACTOR MAILADOPE55 GTV ZIP PMONE SiATELICENSE+ <br /> Q Lw� N L I� — ��TY Z�p pHONE STATE LICENSE M <br /> PIUMBINGCONTRACTOR MAILADDRESS <br /> CONTRACTPflICEOfWORK „^ /�� <br /> ` �� <br /> OESCRIBE WORN AND SOUARE FOOTAGE INV LVED CONTACT PERSON ANO PHONE N0. <br /> ,� ;1 - 19�z '�;�,� oWN�.� <br /> 5 ` �e�C�"A�. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDl15EOFBUILOiNG c,� Q APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> R�5 d�' �L-TC.� PROVISIONS OF LAWS AMD ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESCRIPT10NOFPPOPEPTV�SHOWNBELOW08ATTACHTWOLOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEqFIED HEREIN OR <br /> LOT�y ei�N o� �P ��-Ci� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PPOViSIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofl THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PflOPcRTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS h1ADE AND I COMPLY 1VITH THE STATE <br /> PARLELTA%ID.NUhtOER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION lOAN LENOER.A�DRESS.TEIEPHONE NUTABER C/ � <br /> s��� E � o,r� <br /> PROJECTADDRESS � " <br /> �f � � �j �� /�1nn��7������.•� cirvouzirv[ssuccns r+o <br /> f <br /> MECHANICAL <br /> PLUMBING FEE <br /> Np, TYPE OF FIXTURE OR ITEM FEE NO. �C—A�H DLG NFTS UH P ENT 1— <br /> WATER CLOSET(TOILET) I , <br /> Z, BATHTUB I� ; I FORCED AIR SYSTEMS—B.T.U� � E.A. / � <br /> 3 LAVATORY(WASH BASIN) I� � UNIT HEATERS—B.T.U_ M � <br /> / SHOWER 1 � CLOTHES DRVERS / � <br /> � KITCHEN SINK&DISP � � VENTILATION FAN <br /> DISHWASHER i � � RANGE HOOD i ' <br /> LAUNDflY TRAY ; / WATER HEATER / � <br /> CLOTHES WASHER � � WOOD STOVE ' <br /> URINIIL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT _—� <br /> � HEATPUMP � <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; S GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN I � ' <br /> SINK(SERVICE—BAR.ETC.) � � <br /> � ��. <br /> � <br /> � � � <br /> � SUB TOTAL 5 <br /> SUBTOTAL S � <br /> PERMIT 5 � � � PERMIT 5 _ ._. <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: ��� '� � <br /> PLAN CNE N NUMBEA FEE � RECEIP[[[NO. <br /> FPONT SETBACK REAR SET04CK/ SIDE SETBACK/ ��� . ' //J.tl,,l //��// <br /> � � <br /> �J � FEES VALUATION FEE <br /> USE ONE l0T AFEA VACANT SITE // /- <br /> ' 06 ❑ YES � NO Bui�DiN� _ �" 'Y 7L// 'I_ _ <br /> ttPE Oi CONSi NO.OF 5T001E5 acCuo�.Va h0 ot ONuu•m�n,u — '. � ; <br /> — r � ^0°' PLUMBING ' <br /> wl � ' <br /> SIZE OF OIOG FIRE SPR KlERS REO'0 BASEMENT _ / MECHANICAL <br /> I�t O S Q �-� YES .✓. Nc� � <br /> ADDITIONAL PLAN CHECK ' <br /> OGLUPANCY L D FIRE Al RM REO'� HEIGMT1I�AITATI�N � <br /> GQ OTHER � � <br /> REASON STATE BUILDING Sl1RCHARGE ' <br /> �NTAKEov Pur,��veoer CITY OF EVERETT PUBLIC WORKS � Gt <br /> LOCAL SALES / <br /> DATE�� � c�g TAXCODElS3105 TOTAL lpJ �L��t <br />