Laserfiche WebLink
APpLICATIC"'1 �0�3 COIdSTRUCT'-lI� PERMIT � <br /> (�� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 1' <br /> HEA'fING SYSTEM: `]GAS ❑ ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION Ll BUILDING f l MEC.HANICAL fJ PLUMBING I::I SIGN <br /> OWNER � MAILA�CRESS �ITV ZIP PMOY�y <br /> l0� ��5. �7���-�0 �ill�'rf2(n���(l� 1n11���� 0 -Ut'� �fi�`f- '3�� ��000 <br /> NFNT 1 ILADDRESS CITY ZIP PHO�E <br /> 6L�'nu��r�-��_—�✓�C,�ti� �-n I ��Ati��, ,�ur�.1�1���9�L�G,I��r�(a i 3v�5 �,2�-��Is� <br /> ARCNITECTO� DESIGNER MA�LnUUHt55 CI7Y ZIP PHONE <br /> CaNfJ�,l,06S1G-�►� GlZ�t�.(° (c�.ao ���s l� �S1F�u1�'�fc�T��Z� `��n7�� � o � <br /> GENERALCONTR�CTOR MAILAD�RE..� CITV 21P PHONE STqTELICENSEa <br /> �d,L�� P✓10 <br /> ' MFLHANICAL CONTHACTOP MAIL A�DqESS CRY ZIP PHONE STATE UCENSE a <br /> PWMBINGCONTRACTOR MAILA�DMESS CITY 21P PHONE STATELICENSEa <br /> ,�jONTR�Gt PRICE OF WORK <br /> w GC <br /> DESLPIB WORKANDS��AREFOOTAGEINVOLV� �r GONTACTP, R 0 AN P ONENO ` �U ��J'7 <br /> �� N [� <br /> NA��ih �13��a 5�v�f� �i�a�rin,� � .(l� <br /> �� 'F �a I�._I�f � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaoaoseo use or euaoiNc APPLICq710N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> °RUVISIONS OF'_AWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGFLOESCRIPTIONOFPROPERTY�SHOWNBELOWORATTACHTWOCOPIES� �VORK WILL BE COMPLE7EU WITH WHETHER SPECIFIED HEREIN OR <br /> NUT. THE GRANTING OF i, i'�:t.11T DOES NOT PRESUME TO GIVE <br /> iot e�ocK -- oF — A��'fHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � 'r OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFOAMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anace�rnxi.o.NUMeea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT RS L 1 27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONIOANLENOER.ADORESS.TELEPNONENUMBER � ) �� ipV � � A q� ' <br /> V L� VI <br /> , 1 <br /> F D Q C�/�DDRESS�� � �����r si�r+nrunc on E <br /> � �� � atvousirvessucexser�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WA'fER CLOSET(TOILET) A%C—NHNDLG UNITS—H.P. <br /> BATHTUB ; FORC__ AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH 9PSIN) I UPIIT HEFTEPS—B.T.U. M i � <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK&DISP � I VENTILATIOIJ FAN ; <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HE-ATER <br /> CLOTHES WASHER � WOOD£TOVE � <br /> U1iINAL METAL FIREPLACE(WOOD BURNWG) <br /> DRINKING FOUNTAIP� FIREPLACE WS[RT I <br /> --�— <br /> FLOOR DR,�IN � HEAT PUMP � <br /> BACKF�OW PREVENTERS GAS PIPING I _ <br /> --- � <br /> ROOF DRAINS—RP.INLEADERS L-'YHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> — , <br /> � � <br /> , � � <br /> SUBTOTAL 5 ; SUBTOTAL 5 ; <br /> PERMIT 5 � PERMIT $ <br /> TOTAL FEE S ' TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: �^ <br /> FF� ����' � RE�IlACY. SIOESETBA_ C! PL�NCH�2�MBER FEE�� �S RECEIP�j�/�/ <br /> �� —� 3 O O <br /> usezoNe �otnaen � vacnNTsrte FEES VALUATION FEE <br /> �_1 ._ z ,�� YES ❑ NO gUILDING � , G �'J �u <br /> TIPEOFCONST . �'^.OFSTORIES o[tc�axtv k0a4JwFlux6urui5 � <br /> ��,.� °Po�P PLUMBING � <br /> SRE Of BL�G. FIRE SPRINKLERS REQ'0 BASEMENT � <br /> MECHANICAL ' <br /> �j�IG9 $a �7, rl. O G YES ❑ NO — � <br /> OCCUPANC\'LOA� FIflEFLARMRca'D NEIGHTLIMITAiION <br /> ADDITIONAL PLAN CHECK ; <br /> � <br /> 4o N� - — , <br /> OTHER <br /> REASON -� <br /> STATE BWLDING SURCHARGE i'J7' <br /> INTFNE BV PLANS qPPROVED�Y CITV OF EVERETT PUBLIC WORKS i <br /> �I1 lyti LOCAL SALES <br /> �q� , l z� _ �3 TAX COOE IS 3105 TOTAL ��� � j(� <br />