Laserfiche WebLink
APPLICATIQ�"' FOR CONSTRUCT'"1N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT aE/'�T <br /> HEATING SYSTEM: ❑GAS O ELECTqIC i� <7I� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> iJ DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING !_' SIGN <br /> 01VNER MAILAODRE55 CITY ZIP PNONE <br /> $tR G a V�d�Ca� 502 S C��M S l. -L�CJZ' <br /> TENANT MAILAODRESS CITV ZIP PHONE <br /> s�(tit(� <br /> ARCMITECTORDESIGNER 1.1AILADDRE55 Cltt ZIP PMONE <br /> GENEFALCONTRACTOR MAILAD�RESS QTY ZIP PMONE STATELICENSEY � <br /> AR�ouJ Co��� qq �,� �7 <<frqcJeNE� !/uuSc�G- 9�.� 70 �.54'- /347 ElR2o�co8sScJ <br /> NECMANICALCONTRACTOR lAAILADDRE55 CITV ZIP PHONE STATELICENSEI <br /> PLUMBINGCONTflACTOR MAI�ADOPESS CITV 21P PHONE STATELICENSE• <br /> CONTRACT PRICE OF WORN p /� <br /> 7�'I J� �.30 ,�D �Z 7�(0 <br /> DESCR�I.BIE WORN AND SOUARE FOO��I'VOIVED� /O a / CONTACT PERSON AND PHONE NO. <br /> / /D.v f <br /> `7T� a� ���5 65 9- 1397 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE BUaO�NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L I�C7.!J � �� L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> IEGALDESCRIPTIONOfPROPERTY�SHOWNBELOWORATTACNTN'OCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocK oF -5���-36 �WP '�9 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AI�THORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �C O�/ 2T 33F) [3��q tJc% cnQ S�S�Sc�lN�1R'� C �HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 7�, - Nt cc i�r - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ya �oF �� St 71�SF7 p6 n+ cc.�T 5t NcF7 TN�x� i:,'n'rw�x OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICIi <br /> APPLICAT�ON IS MADE AND I COMPLY WITH TF{E STATE <br /> PARCEL TAX I.O.NUMBER`��� O�[l_ O _ O36 �Q� ` CONTRA TORS LAW 1827 RCW AtJD 296.2 WAC. <br /> 1 7 <br /> CONSTRUCTION LOAN LENDER,RCDRESS,iELEPHONE NUMBER <br /> £. � 3 Au � <br /> PRaECT ADDRESS / /�,� �cr�+roac oac <br /> O�� L/�I�/` S��G� Ci�Y0U5WE55lICENSENO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FD(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIHNOLG UNITS—H.P. I <br /> BATHTUH FORCEU AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.I I, M ; <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL ' METAL FIREPLACE�WOOD BURNING) � <br /> DFINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DiiAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � ; <br /> - � --— ; <br /> � � <br /> SUBTOTAL $ ; SUP.70TAL 5 ' <br /> PERMIT $ � FERMIT 5 � <br /> TOTAL FEE S ; TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONT SET04C; REAR SETBRCK/ SIDE S�TBACN > PLAN CMECK NUMBER FEE RECEIPT NO. <br /> �d 2v s � �i5 9.3 �� �oss� <br /> USEZON= , �oTnaen vncn sire FEES VALUATION FEE <br /> -; YES ❑ NO 'Z O /�� <br /> BUILDING � <br /> TYPEOfCOHSi. NO.OFSTORIES ocuivaNtr NOo6oKtu�k6wnt5 ---� <br /> , I S0°3 PI UMBING <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D OASEh1ENT � � � <br /> 2�jJ s � �Q ❑ YES VNp M�CHANICAL i <br /> i <br /> OCCUPA�N,CIY OAD FIREALAR�M�REOD HEIG/H�T�LI,GM�IT-A710 AODITIONALPLANCHECK � <br /> 1� 1\� ``-' � OTHER i <br /> REASON <br /> STATE BUILDING SURCHA(iGE ;� — <br /> INTAKEBV PI�NSA PROVEDBY CITYOFEVERETT PUBLICWORKS -�� <br /> �N LOCAL SALES ' <br /> D�TE 8 � TAX CODE IS 3105 TOTAL �[ � `yZ� <br />