Laserfiche WebLink
APPLICATION FOR CONSTRUCTION -PERM�� �(►y/�� <br />TO .:OMPLETEO IN BLt CK INK -PLEASE PRINT <br />HEATING SYSTEM: ❑GAS DIELECTRIC C.1 ' 3 i99 nfl <br />BUILDING DEPARTMENT - 8 <br />DEMOLITION : I COMBINATION _A <br />Ns..J. MAIL AORAESs <br />MAIL <br />LICENSE { <br />LICENSE E <br />PLUMBING CONTRACTOR MAR ADDU SS C.I ZIR RACNE STATE LICENSEE <br />�P�br'o`Sery es <br />y41 <br />CONTRACT WORK <br />DESCRIBE WORK AND $ONARFEOpiAGE rN\'IX\'ED <br />CY?�_S PE,,N$JN AND PH -NE Lip __11 <br />1�1'AQj FY_Y1iP Ste. VV CYLTS <br />boa <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 PE..IAIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW LIEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION .S MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS I♦AWW 118 27 .R/CyWAND 296.200 WAC <br />yG!7� <br />scn.in oMt"� a 9 <br />PRo= Eo u - of Ow uGC I __ <br />LEGAL OESLRORIONOF PROPERTY ISHOWM BELOW OR ATTACH TWOCOPIESI <br />LOT BLOCK OF <br />PARCELTALI NU ER <br />� r� OS 0 <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />ROJECT AODRV$S P/^ % I �IME[ <br />uas.r.essuuxsero <br />PLUMBING <br />MECHANICAL <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />140. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—A'HNOLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU. M E.A. <br />LAVATORY IWASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />LOTHESORYERS <br />\KITCHEN SINK 8 DISP <br />TI.ATION FAN <br />D WASHER <br />AN H000 <br />LAURkAY TRAY <br />WATER ATER <br />_ <br />CLOTH ASHER <br />WOOD STOVk <br />URINAL <br />METAL FIREPLA. I WCOD BURNING) <br />DRINKING FOU N <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />PUMP <br />BACKFLOW PREVENTER <br />_HEAT <br />;;AS PIPING <br />ROOF DRAINS—RAINLEADER <br />EXHAUST FAN <br />�— <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL_ $ <br />PERMIT $1 <br />PERMIT $ <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SERIMI <br />REAR SETBACK <br />SIDE SETBACK <br />PLWCHECKIMMBEP <br />FEE <br />RECEIPTNO <br />wEZONE <br />LOT AREA <br />VACANT WE <br />O YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />-- <br />rr q DI:51 <br />�� <br />NO OFSTORIES <br />O[RPNEV <br />uD tlPMURRMnp <br />PLUMBING <br />SIZE OF BLCG <br />ACRE Sg.7r LEAS REM <br />BSEYMNT �ND <br />f-I <br />MECHANICAL <br />�— <br />CUP• CV�Wp <br />00 <br />pIAEWAARRMREOD <br />Es <br />NEIONTLRATAIIgi <br />ADDITIONAL PLAN CHECK <br />OTHER <br />� <br />REASON L n <br />coot 61Lo r <br />STATE BUILDING SURCHARGE <br />--T <br />muxE ev <br />PLINSAP R NIiDBr <br />CITY OFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />' <br />TOTAL <br />lMP Es <br />F <br />F] <br />