Laserfiche WebLink
APPLICATIOId FOR CONSTRUCTION Wl:RMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: i- GAS U ELECTRIC iJ — <br /> 259-8810 <br /> DEMOLITION ! COMBINATION I i BUiLDING � MECHANICAL Ci PLUMBING I:I SIGN <br /> OWNER M4ILADDRE55 CIN ZIP PHONE <br /> ST�ii� !✓icui9rlS l�32O-/96 Sr 5�.1 yj'a-}�p, LyN.V[.bt�/J, G✓.4 , �7D36 �38-bon�. <br /> T[NANT MAILAODFESS CITY ZIP PHONE <br /> /`f//f� /�JL y/,���Svn.� f- Z3Z�- !3 LU/"!�°�O ,�j(/. � Fa'£✓'.�Li/ W%9 • <br /> �RCHITECTORDESIGNER E".AILaDDRE55 GTY ZIP PHONE <br /> GENEFALCONTR''AG/TOR IdAILA��RE55 CIiV ZIP PHONE STATELICENSEa <br /> O��j-v E� ' <br /> MEGHANICALWNTRACTOF 1dAILADDRE55 GTY '.IP PMONE STqTELICENSEa <br /> PW6IBINGCONTPACTOR M1IAILAODRE55 CITV ZIP PHONE STATEUGENSEn <br /> CONTRACT PRICE OF WOPK <br /> St70 ^ I,ODO _ <br /> OESGFI3E WORK AND SOUARE FOOTAGE INVOLVEC COIJTACT PERSON AND PMONF NO <br /> PLAC-� C�.e9l-� ,ovv2s 3 wir.� ST��/� a./iLc.i�9rls "��z� -6�0'�' . <br /> wilrti , rd.�✓Dnui �eti0 Dvn.e . <br /> i HEfiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSeO USE OF 9UROMG APPLICATION AMD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � S/,✓GL� /�9�• ��S • PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> l[GFLOESCRIPTIONOFPROPERTY�SMOWN�ELOWOH9TTACHTWOGOPIES� WORK WILL E'E COMPLE?EO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFlNNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF — AUTHORITY 1'O VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AN� I COMPLY WITH THE STATE <br /> PnRce� UMBER CON7RACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��°�'�-�9��13 �ce9 g <br /> �py57RUCilONLOANLENOER.A��RESS TELEPHONFtJUtABER / ./ / <br /> �'z ,GrlG ` �� S�i/9ft . <br /> C1i.v� <br /> PROJECT ADDRESS sicr uae oater� <br /> G DOSiI:ESfiliCF1�5[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORC�D AIR SYSI'EMS-6.T.U. M17 E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M _� <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDI',i TRAY ; WATER HEATER ' _ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR. ETC.) I <br /> , <br /> SUB TOTAL S ' SUB TOTAL $ ' <br /> PERMIT S � PERMIT 5 <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: � <br /> FRONTSETBACK REARSETBACN SIDESETBAGK PLANCMEGKNUMBER FEE / RECEIPTNO. <br /> t <br /> usezoNe �oTnRen vncnNrsiTe FEES VALUATION FEE � <br /> � <br /> ,-i YES � NO BWLD�NG ' <br /> iYPEOFCONSi. NO.OFSTORIES a�Cu>ar.Cv rmaro'.vEurt:cupus - � <br /> C9�0' PLUMBING i <br /> i <br /> 52EOFBLDG. FIRESPRINKLERSREO'D BASEAIENT MECHANICAL � <br /> �. �. '!ES '�.-: NO � <br /> OGCUPANCVLO�D FIRE�L4FMPEOD HEIGHiLRAIT�TION AUDITIONALPLANCHECK i _ <br /> � <br /> OTHER <br /> T <br /> REASON <br /> STATE BUILDING Sl1RCHARGE i <br /> INi�NEBY PLANSAPPROVEDBY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTAL <br />