Laserfiche WebLink
m <br />A <br />Ax7x <br />al-3v <br />IF <br />H <br />Hw <br />'OO cl) H <br />H <br />05 <br />H3 t7 <br />OH <br />Hog <br />zH <br />�y <br />` HH <br />gto <br />H <br />Cq'. t7 N <br />mv <br />[+I tX1 <br />HOfn� <br />.; Oft <br />,-.PPLICATION FOk <br />III, E <br />ITV <br />CIn OF <br />°"'" <br />CONSTRUCTION <br />everett <br />PERMIT <br />BUILDING DEPARTMENT <br />TO BE COMPLETED IN INK- PLEASE PRINT <br />259.8810 <br />InnFMn11TION PI C/ OMBINATION O BUILDING ❑ MECHANICAL <br />❑ PLUMBING <br />❑ SIGN <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE. <br />woe(2— <br />CLASS OF "FIX <br />❑ NEW ❑ ADDITION .pp ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPLANSERT ❑ BUILDING RELOCATION <br />VALVATIONOF WORK(COST OF MATERIALS PLUS LABORI <br />DESCRITOF 1 -1% . I J-_ "4. l/1I n o c <br />li-di,64 IIOMK I I u,I — <br />USE OF BUILDING <br />ELCeP 5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAME TO BETRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF NTRACTOR OR AUTHORIZED AGENT DATE <br />x t, <br />LEGAL DESCRIPTION Of PROPERTY ISHOWN BELOW OR ATTACH FOUR COPIESI <br />LOT_eLocK—_oF <br />- <br />PROJECT ADDRESS <br />APPLICANTS YBUSINESSUCEA <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILET) <br />AC — A/HNDLG UNITS —H P <br />BATHTUB <br />REFRIGERATION UNITS — H P EA. <br />LAVATORY (WASH BASINI <br />BOILERS — B.T.U.JH.P. <br />SHOWER <br />GAS FIRED A.C. UNITS — BT.U. <br />KITCHEN SINK 6 DISP. <br />FORCED AIR SYSTEMS — 0111, M EA. <br />DISHWASHER <br />WALL HETERS—B.T.U. M <br />LAUNDRYTRAY <br />UNIT HEATERS —B.T.0 M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />URINAL <br />CLOTHES DRYERS <br />DRINKING FOUNTAIN <br />VENTILATION FAN <br />FLOOR DRAIN <br />RANGE HOOD <br />BACKFLOW PREVENTERS <br />WATER HEATER <br />ROOF DRAINS — RAINLEADERS <br />WOOD STOVE <br />$INK ISERVICE —BAR. ETC.I <br />METAL FIREPLACE f CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />— <br />AL <br />PERMIT <br />f <br />PERMIT <br />PERMIT <br />TOTAL fEE <br />f <br />� <br />_I <br />TOTAL FEE <br />PLAN CHECK NUMBER <br />FEES <br />FEE <br />VALUATION <br />RECEIPT NO. <br />FEE <br />I RONT SETBACK <br />USEZONE <br />REAP SETBACK SIDE <br />LOT AREA <br />SETBACK <br />VACANT SITE <br />OYES ONO <br />BUILDING <br />S <br />TYPE OF CONST <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />PLUMBING <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX OCC. LOAD <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED OYES ONO <br />STATE BUILDING SURCHARGE <br />STATE ENERGY SURCHARGE <br />APPLICATION ALC BY <br />PIANSCNECKEDBY <br />APPR FOR ISSUANCE DY <br />PUBLIC WORKS <br />TOTAL <br />_____�........ L.... .nv wvconlJawl F Rnn OFTFRMINING ALL <br />PROPER r vnncna nn.. L..... _ <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />