Laserfiche WebLink
APPI.ICATI� FOR CONSTRUCT�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT °' <br />BUILDING DEPARTMENT �- <br />259-8810 <br />❑ DEMOLITION ❑ COM8INATION <br />OWNER MAILAD�RE55 <br />�-_ � � i" , l . <br />ARCHITECTORDESIGNEfl AIAILAOORE\55 <br />L a: .��. . $1/^.:� �/.i <br />GENEf1ALC� MAILADDFE55 <br />11 ;^ .s 7'� / ( . <br />MELHANIGAIWNTRACTOR MAILADDiiE55 <br />PWMBINGCONTRACTOR MAILAOORESS <br />CONTRACT PRIGE OP WORN <br />,,� � '-�� � i_'✓ C�J <br />HEATING SYSTEM: CxGAS ❑ ELECTRIC ❑ <br />B� UILDING I(IMECHANICAL <br />CITV ZIP PHONE <br />7l %S � „�oi:.�/Sl� iv�J <br />CITY 21P PHONE <br />CITY ZIP PHONE <br />� -� i 1 S� <br />CITV <br />�, , <br />/��k <br />CITY <br />ZIP <br />) � �� <br />ZIP <br />ZIP <br />PMONE <br />.i"" <br />PHONE <br />PLUMBING <br />! '. �/ <br />_� �. V <br />STATE LIGENSE a <br />` l��ii�o.4�i <br />STATE LICENSE a <br />STATE �ICENSE p <br />❑ SIGN <br />� %% <br />, ,- <br />�ESCPIBE WORK AND SOUARE FOOTAGE INVOLVED �� CONTACT PEPSON AND PHONE NO. <br />'I��.. ;r '� -�)ti�' <br />� ' � � � <br />7 d':� '`/l i , � 1 � 1 -� � � �. � - J � �- ._ J �. � � - <br />�, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSEDUSEOFBl11L01NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />S%%�_ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGALOESCRIPTIONOFPROPEFTYISHOWNBEL0IYORATTACHTWOCOPIES WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />� �� �,��� ��j� i�%J NOT. THE GRANTING OF A PERMIT DOES MOT PRESUME TO GIVE <br />�oT eiocK oF �—1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />��� `� � ��.`� � �_, f �G OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU'HORIZcu 9Y THE <br />��,, ,_. �� " ` i 7 � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHiCH <br />� � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PAPCELIAXI.D.NUMBEF � � CONTRACTORS LAW 18.27 RCW AND 29G200 WAC. <br />CONSTRIICTION LO�ENDEA�/, AODRESS,//7ELEPNONE>NUM9ER (� I /� � � `�, . � /C %C <br />�l '• � � ��� �-( I�r � i if ' .J '� � . _.� �. � / � fi � { -� <br />PROJECT ADDRESS � ' sicrinrune'� r �� o"'E � <br />TYPE OF <br />LAVATORY (WASH BA: <br />SHOWER j� <br />KITCHEN SINY. & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK ISERVICE—BAR <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />NO. <br />TYPE OF EOUIPMENT <br />NC—AIHNDLG UNITS—H.P. <br />FOACED 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 <br />METAL FIREPLACE (WOOD <br />FIREPLACEINSERT � <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN / <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SFTBACK SIOE SETBnCK PLAN CHE K NUh1BEF <br />/o � 2a''�PA '' /8` � .35-� <br />USE 20NE LOT AREA V�CANT SIT FEES <br />❑ YES ❑ NO BUILDING <br />ttPEOFCONST NO.OFSTORIES aCUcauCr NoovoHEurvcmats <br />�— I � -Aouv ' pLUM81NG <br />e <br />RE�SON <br />INTFNE BY <br />FIflESPRINKLERSFEd'D BASEM�IJT MECHANICAL <br />L�YES ❑ NO <br />FIRE nta�M REO-D HEIGHr �I4^�TpT�N AD'JITIONAL PLAN CHECK _ <br />✓JG2 � <br />l�LJ OTHER �� �:i. � ?: `.. <br />STATE BUILDING SUriCHARGE <br />PLANSAP?R��EDBY CITY OF EVERETT PUBLIC WORHS _ <br />V j�' LOCAL SALES <br />DAIE 3�� �. TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FEE <br />��5. c� % <br />iav <br />