Laserfiche WebLink
APPLICATIQ� ; FOR CONSTRUCT"-lN PERMIT ��� <br />;1�\ TO BE COMPLETED IN BLACK INK-PL:EASE PRINT <br />�� <br />BUILDING DEPARTMENT L HEATWG SYSTEM: L] GAS U ELECTRIC L] <br />259-8810 <br />f I D@MOLITION ' COMRINATION i i BUILDING I l MECHANICAL �PLUMBING i i SIGN <br />06NER 11NL 1pDRE55 CITV ZIP PMONE - <br />a%�'��0'�'t�tiC7 I�e�i���C_ ��C�rP�t2,. (.liN-�`.�`��.i�l o`1Db-25�-UU4-�-i <br />TF.NANT MAILADDdE55 CITV ZIP PHONE <br />N OrU �. <br />ARCHIiECTOflDE51GNER IAARADDFESS CITY ZIP PHONE <br />�i1C_l+=c�2C��+1N� <br />�LERALCONTRACTOR MAILAD�RFC� CILV 21P PNONE SiATELIGENSEtl <br />\ <br />\-�r'\c��-� � �'0(�4�� k'����c�� `�c�\S `Z�'�'`�S�.N�c. �L-K,�i�rv�rv�lc., <br />1.4EGHANICALCONiRACTOR MAILqODRE55 QTY ZIP PMONE STAiELICENSEx <br />JA � lAAIL <br />�Jl��\'L.)\C <br />lYOflH U <br />/� O/ <br />WOPK <br />_ r_ <br />USE OF BUILpINCt <br />OF PROPERTV( I�S,I(IO�WN PCIOW OR ATTACL�H TV/O COPIESq� <br />- BLOCN —��—i OF ��`-\"]� U'S <br />PAFGE�TA%ID.NUMOEP <br />COtJSTRUGTION L04N LEN�ER, ADDFESS. <br />PLUMBING <br />TYPE OF FIJCTURE OR ITEM <br />LAVATORY(WASHE3�: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />UFINA� <br />DRINKING FOUNTAIN <br />FLOOA DFAIN <br />BACKFLOW PREVENTERS <br />ROOF �RAINS—RAINLEADERS <br />SINK (5[R610E—BAR, ETG) <br />SU�TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />PROYTSEIDACK NE�FSETpAGK <br />USE20N[ LOT�REA <br />iY7E0FCONSi NO.OFSTOlilES <br />SIZEJFB�DG. FIFESPRINKLEPSREO'D <br />FIRE ALAPM R50'D <br />REASON <br />INTpK[BY I PL�RSAPPROVEDBY <br />DATL <br />VACANT SITE <br />❑ YES f NO <br />oauranw uoorox�a�ri;u•.�is <br />caauv <br />BASEMENT <br />� YES � � NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CflUE !S 3105 <br />ZIP (��'N(O��NE STATELICENSE> <br />111� � �l.Y.�(�� <br />< <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE HND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WII.L BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE CiRAIJTING OF A PERMIT DOES NOT PRESUh1E TO GIVE <br />AUTHORITY TO VIOLA?E OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR �fH� <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPUGATION IS MADE ANC I COMPLY WIThI THE STATE <br />CONTHACTORS LAW 18.27 RCW AND 296.200 WAC. <br />,�' 11 � �� r�,, �'yu�,f� 9- � 3--�3 <br />_iG'lnlpql. UAiL <br />Grvp; .. I`f'.O � <br />MECHANICAL <br />J0. TYPE OF EOUIPMENT FEE <br />AiC—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER '� <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT i <br />HEAT PUMP � <br />_ u'AS PIPING __ <br />EXHAUSTFAN � <br />PL�N C46CH N111.13ER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAI PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />PUALIC WORKS <br />TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />F[E RECEIFTt10. <br />VALUATION FEE <br />— � <br />� <br />i <br />— 1 <br />� - <br />