Laserfiche WebLink
A�PLICA�1�'"! FOR CONSTRUCT''"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINIf <br />HEATING SYSTEM� [] GAS U ELECTRIC <br />BUILDING DEPARTMENT ' � <br />259-8810 <br />❑ DEMOLITION C7 COMBINATION [; BUILDING I�MECHANICAL J PLUMBING [_i SIGN <br />OWNER n MAILAODRE55 ,� _ , _ CIIY �21P PHONE <br />GENERAL CONTRACTOR 1AAIL <br />CONTRFCTOR MAIL�DDRE55 <br />��T� Z�F PMONE SiATELICENSEa <br />CITY IIP PHONE STATELICEN3E� <br />�e.�2tt �'Zo7 7c-� .�// f__�� <br />CIiY TIP PMDNE STATE UCENSE P <br />CONTRf.CT PRICE OF WORK� eU <br />S� DOp_ <br />DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED <br />PHOYOSE�US F6WL�ING <br />(: �T/PG <br />LEGAL OESCh�PTION OF PROPF <br />�oT n: � �, <br />BELOW OR ATTACH RVO COPIES� <br />- oF <br />PA7CELTA%I.D.NUMBER <br />CONSTRUCI'I@I LOAN LENOER, AODRE55, TELEPHONE NUMBER <br />PROJECiADDRESS <br />ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CI.OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DPAINS—RAWLEAC <br />F'EE <br />SUBTOTAL S <br />PERA7IT S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSETBACK <br />iVPcOFCONST <br />SIZE OF BLDG. <br />OGLUPANCVLOA� <br />RfA50N <br />AREA <br />OF STOflIES <br />FIPE SPRINKLERS REO'D <br />FIPE ALAflN REOD <br />1':ANS A�P,^PROVED BY <br />DATE��I . Il n <br />SIOE SETBACK <br />�� <br />CONTACT PEPSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF �.1WS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL OE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOcS NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION CR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I �M AUTHORIZED BY THE <br />OWNER OF THIS PROPEI3TY 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 WAC. <br />X Cl <br />� 9 z•�/ �3 <br />SiGNAIDR� � �ATE �� <br />LIiYPU5rNE5511^_ENSE NO <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER <br />WOODSTOVE I <br />METAL FIREPLACE (WOOD BURN WG) � <br />(IREPLACEINSERT � <br />HEHT PUMP � <br />GAS PIPING ; <br />EXHAUSTFAN � <br />VACANT SI1E FEES <br />❑ YES ❑ NO BUILDING <br />OLL�PANCY NO OfDKFLUNG0111i5 — <br />ceoua PLUMBING <br />BASEMENT 1dECHANICAL <br />❑ YES ❑ NO <br />HE!GHTLIMITATION �DDITIONALPLANCHECK <br />OTHER <br />STATE BUILO�NG SURCHARGE <br />CITY OP EVERETT PUBLIC WORHS <br />LOCALSALES <br />TAX CODF IS 3105 rora� <br />SUB TOTAL $ - <br />PERMIT $ _�; � <br />TOTALFEE S � <br />/ '� `� � <br />FEE RECEIPTNO. <br />VALUATION FEE <br />�— <br />i <br />� <br />� <br />