Laserfiche WebLink
APPLICATIC : FOR CONSTRUCT.' )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 47T <br />BUILDING DEPARTMENT L- <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />ADDRESS <br />NERaL GONTflACTOR <br />MAIL <br />u_FRG£n/i <br />&T, <br />MECHANICAL CONTRACTOR <br />MAIL <br />T <br />0 PLUMBING CONTRACTOR <br />MAIL <br />B <br />I CONTRACT PRICE OF WORK <br />iEATING SYSTEM: 'J GAS ❑ ELECTRIC U <br />CITY ZIP <br />PHONE <br />'%ymnu (A-405N <br />3(O.3z$•(o;0a <br />CITY ZIP <br />PHONE <br />TOYY0.nCe QQ4;_1 <br />3ID- <br />9 22 - <br />(030o <br />CITY ZIP <br />PHONE <br />nlyArYe (a 6105DI <br />-5I-0- <br />s 7--?- <br />to3o-o <br />CITY ZIP <br />PHONE <br />STATE LICENSE 0 <br />mLSw `1ZQQR <br />e7-4�v�S <br />[ <br />- <br />CITY /J/J ZIP <br />PHONE <br />STATE LICENSE # <br />CITY ZIP PHONE STATE LICENSE, <br />SIGN <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSONJAND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />rL1�'ymous Foot�wea-I' Flo gKptess eum'I-i-s <br />�"^�� m J�nl(h- /-}!fn f l tl ^' 9 (,_ <br />PRop <br />� <br />ns�Dt'y-��t <br />pF eu Iy�' <br />l 111 <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />PROJECT ADDRESS <br />1, <br />W <br />$IUNATU <br />DATE <br />CRY BUSINESS LICENSE <br />NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE S. <br />FOR OFFICE USE ONLY: z <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHEC NUMBER r <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />57.� ; Q <br />TYPE OFCONST. <br />NO. OF�ORIES <br />OSCUPeNtY <br />BN <br />NB. BEVNBLINIT UNITS <br />PLUMBING <br />i <br />I <br />ArSIZE OF BLDG. <br />✓�13 %,�- <br />FIRE SPRIV RSj RED D <br />BASEMENT <br />❑ YES f$ NO <br />MECHANICAL <br />j <br />OCCUPANCY LOAD% <br />FIRE ALAI}�7J�1�R/E00 <br />HEIGHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />I <br />i <br />REASON �J /9-0/ <br />�j �� 111 <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLANS•APP`ROVED BY <br />V1�1 <br />DATE �p .� <br />EVERETT <br />L SALES <br />7TAXE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />,n <br />W �`� <br />�� <br />