Laserfiche WebLink
APPLICATIQ�' FOR CONSTRUCTt�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: I GAS ❑ELECTRIC :J <br /> BUILDI�JG DEPARTMENT <br /> 259-8810 � <br /> ! ' DEMOLITION �l COMBINATION C! BUILDING �%AIECHANICAL I 1 PLUMBING I l SIGN <br /> OWN MNILADDRESS CITV ZIP PHONE <br /> IM �L.Lti �/oD G G��..���c� �✓ � ���e�7,- aSx- ��5� <br /> T NANT �MAILADDPESS CITV ZIP PIIONE <br /> ARCMIiECTORDESIGNEP MAILADDRESS CITV IIP PHONE <br /> GENEPALCONTFACTOR MAILAO�RE55 CITY ZIP PMONE STATELICENSEs <br /> �j CMANICAL CONTRFCTOR MML�DORESS GTY 21P P�,U7S� STATE LICENSE 1 <br /> C�J-[-�JDOE1 ,���i✓C� � �rs^��in/G I�OGG N� >S Si �..�4m�.�✓!_1 IPc-0«v.�Cof'(oQl�. <br /> PLUMBINGCONTRACTOR MAILaDORESS QTY 21P PHONE STATEI.ICENSE• <br /> CONTRACT PRICE OF WORK � M Q(J � <br /> (/�/ <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVEO CONTACT PERSON AN�PHONE NO. ✓ <br /> i��T_8gi -o�sg <br /> �eve� pi� Fwe,� P I�c� w,nr GTs <br /> /S»�a • t2 - r Ncc• w� Gn I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PFOPOSEDUSE OF BUILDING / APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S �/' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALOESCPIPTIONOFPROPERTV�5H0 NOEfOWORATTACHTWOCOPIES) WGqK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK oF AUTH(1�9'TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER S In'E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORA1ANCE 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 COMPIY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRAC/TOfRS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRULTION LOAN LENOER.ADDRE55.TELEPNONE NUMBER /�J / r l'+� f{ _ /7 S �4 <br /> i <br /> Y -I3.f�!</ / t./ o, <br /> PROJECT ADDRESS `�'"*`�a` o"t0 <br /> LI1V OUSWESS IICENSL NO <br /> � p�� q MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C-AIHNDLG UNITS-H.P. � _ <br /> BATHTUB ' FORCED AiR SVSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> SHOWER ' CLOTHES DRVERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER <br /> CLOTHES WASHF_R � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTEPS ; GAS PIPING � <br /> � ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE-BAR.ETC.) ; � <br /> � <br /> � <br /> � � <br /> � ' <br /> SUB TOTAL 5 ; SUB TO AL ' <br /> PERMIT S � PERMI � <br /> TOTAL FEE $ TOTAL EE �i' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAR SETBAGH SIDE SEiBACK PL�N CNEC NUMBE FEE RECEIPT NO. , <br /> usezone LOTAREA VACANTSITE F ES VALUATION FEE <br /> r' YES -! NO _ BUILDING ' <br /> 7YPE Of CONST. NOAF STORIES otCuvAxtv No c�Vnnbvc ccrt!� <br /> tnour PLUMBING <br /> �i- <br /> SIZEOFBLDG. FIRESPRINKLERSREO'� BASEMENT MECHANICAL � <br /> i.-. YES !-'�, NO � <br /> OCCUP�NCV LOAO FlRE ALARM REQD NEIGHT LIMITATION ADDI?IONFL PLAN CHECK i <br /> O7HER � <br /> REASON i <br /> STFTE BUILDING SURCHARGE <br /> INTAKEBV PLANSNPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES <br /> ��r� TAX CODE IS 3105 TOTAL <br />