Laserfiche WebLink
v <br />APPLICATI�C^1 FOR CONSTRUCT" 1N PERM�T � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYST[M: ❑ GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />x OWNER MAILAD�RESS CITV ZIP PHONE <br />!�i k� PFc<A�^t �I�� R;�en;de D/' /l�*�i/NOnI rsz>3 4�y'6<,6� <br />T�IA_Ni � `� I� MAIIADORESS CITV 21P PHONE <br />I ��) /'Tl� l. /' <br />ARCHRECT <br />x � �) � 2� _Mo E <br />MECNANICALCONTPACTOR <br />MAIL AD�RE55 <br />MPIL ADDRESS <br />WNTR�CT P/RI�CE O�F WnORnK <br />� ///(l <br />OESCRIBE WOP AND SOUARE FOOTAGE INVOIVED <br />�' �'' �% �J�i'r�iYi � // <br />GI�Y LIY <br />CIN 21P <br />� Rc� M�' Ue�u�,� 5 <br />arv zm <br />CITV 21P <br />� D� Irra' a � ilrl�Yl�Otf � <br />PPOPOSEO USE OF BUILDING <br />LEGFL DESCRIPTION OF PROP[RN (SHOWN BELOW OR ARACH TWO COPIES) <br />LOT BLOCK Of <br />�PARCELTAXID.NUMBER <br />1St7S�n�-3'C <br />NO. � TYPE OF FIXTURE OR ITEM <br />—�WATER CLOSET (TOILET) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />CRINKINC FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREb'�NTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN FEAflSETBACK <br />USEZONE LOTAREA <br />TVPF.OFCONSi. NO.OFSTORIES <br />� , <br />SIZE OF BLDG. FIRE SPRINKLERS REO'D <br />�d �F ,qqv. NO <br />OCCUPANCY LO�D FIRE ALARM REO'D <br />� IIJD <br />INTANE BY PLANS-A1PpPAROVEDBY <br />�ATE {/�.%I-/S <br />PMUNt <br />Yz4 <br />PHONE <br />CONTACTPEPSONANDPHONENO. <br />s ini e ucenae a <br />(JAUE n <br />STATE �ICENSE p <br />STATE LICENSE p <br />I HEREBY CEFiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />P(i0VI510NS 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 PRESUPAE TO GIVE <br />AUTHORITY TU 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 />OWNEF 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 WAC. <br />�y <br />� �r„ .o /Iti c� _ � - f 4 - ��I <br />FEE I NO. <br />OF EOUIPMENT <br />FORCED AIR SYSTEMS-8 <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />tdETAL FIREPLACE (W000 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXFIAUST FAN <br />SI�ESETBACK PLANCHECKNl1R19ER FEE <br />2 <br />VACANT SITE FEES <br />C YES ❑ NO BUILDING <br />OttOPAIICY NO Of OWELLIAG UNIIS <br />A� � PLUMBING _ <br />BASEMENT MECHANICAL <br />❑ YES �1 NO <br />HEiGH7uMI7ATI0N AD�ITIONAL PLAN CHECK _ <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />FEE <br />M E.A. <br />SUB TOTAL $ ' <br />PERMIT $ <br />TOTAL FEE $ ' <br />�� <br />RECEIPT MO. <br />VALUATION FEE <br />D40 , �/D 2i — <br />i <br />� <br />i <br />� <br />i � <br />i <br />i <br />i � <br />i <br />—r <br />� <br />� <br />