Laserfiche WebLink
APPLICATIC=�1 �OR CONSTRUCT �I�! PERiVIiT �� <br /> TO BE COPAPLETED fN BLACK INK—PLEASE PRINT <br /> Bl.'ILDING DEPARTMENT HEATING SYSTEM: J GAS � ELECTRIC J � <br /> 259-8810 <br /> DEMOLITION COMBINATION ILDING MECHANICAL PLUMBING SIGN <br /> cca:e-. � r.�ni�anoaess c�rv za FHor.=_ <br /> __ ��,�,� Q /5 ,��1��'� �'.�,z�,�-� 9_�a��s 7i� - $s�b <br /> -::r:a��T�+ r r.ifni�nooaes ci�r /1 pzi,a ahor�e <br /> �C� /— �71�Tlf..e�C.t �Y �lJ� r2V1?c�2f'I' /�S�_—�i'_ `�69� <br /> ARCNiiECTORpESiGNEfi IAPiy�DDRE55 � CiTY Z�P PHONE <br /> �Ar1 -/1>tfi'��2 Ocutiit�Q <br /> GEliERA�I��' J)iFACTOR L:AI�FODRE55 CRV Z�P PHONE STATEUCEIlSEa <br /> —�eL��'V <br /> 1.'.ECHANiCALCONTR�CiOii IdAILApDRE55 LiTY ZIP PNONE STATELICENSEe <br /> \ <br /> PLtI!A8INGCONTflACTOR IdAi�ADDRESS CitY ZIP PHONE SiATEL�CENSEk <br /> � <br /> GpNTRAQ PRICE OF Y!0 J <br /> \`_ Q.:..�/� `J�', i��-� <br /> CESCRIPEWOFKANp50l1AREF OTAGEINV IVED CONT4CiPEP50NANOPNONENO. <br /> �Al�1-l;�,� -�� � i <br /> Z� Sf <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaocosepuse oF piypiric APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � f� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eca�oEscaivnor�oFvaoaeaTv,sHowNee�cw�oannJnc�nvocoa�esr �A WORK WILL BE COMPLETED VJITH WHETHER SPECIFIED HEREIN OR <br /> �oT� e�ocK�� pF .y-IVr��C� �v A�7d NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OP, CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAtANCE OF CONSTRU�TION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TJ PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANC I COMPLV WITH THE STATE <br /> PAq�ELTA%ID N�1dBER <br /> 5���� CONTRACTORS LAW 1827 RCW A 296200 WAC. <br /> `i <br /> CONSTRUCTIO�lLOANLENpER.�DpRE55 EL PHONENUTABER <br /> �� � THi�r£2'G� UfL � _ /�"� �'J3 <br /> (_�ROJE�DDRESS �'�'+���N� o^�E <br /> Oiv Bv5'FE54��CI 1nf LP <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPF OF EQUIPMENT FEE <br /> ( WATER CL.OSET(TOILET� A'C—A'HNDLG UNITS—H.P. <br /> ( BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD —� <br /> LAUNDRYTRAY WAT[R HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URiNAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREP!ACE INS[RT <br /> —� <br /> FLOOR DRAIN HEAT PUMP <br /> �ACKFLOW PFEVENTERS i GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) <br /> �� <br /> � � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT $ PERMIT S <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: �U/, � <br /> i'RONiS[TBACK RFMSETB�CK SIOESETBACK PLfNCHE KNIIMB[R FGE / RECEIPTNO /� <br /> 20 �v s s�,�5� ��oG,>� �7r'S - <br /> u�aezoN=_ �ornqEn vncaNisire ��L FEES VAWATION FEE �, <br /> -( Z 5�000 ��. YES �V NO eui�oiNc <br /> <� �.�� �,25(a 3a1� � .�<� <br /> 1VFi0FCON5i NO.OFSTORIES ocaap,Cr C�orpe:uu�.;uY�is — <br /> � �• ' °;3 � PLU6161NG � i(��) <br /> �N <br /> 52EOFpLOG RFESPRMNLERSHEO'D BFSEMENi � � MECHANICAL � <br /> S� f A Q -� YES :I�NO � <br /> pCCUPANCYIOAD FlpEALARldIR/WD HEIGHTUIdITFTION ADDIfIONALPLANCHECK i <br /> _�I�A nV _ Z� f OTHEF <br /> qensori <br /> STATE BUIL�ING SURCHARGE is� <br /> ,�;�n�=_ev — � rim,snaanoveoov CITYOFEVERETT r�u[3ucwoaKe. <br /> J� LOCAL SALES <br /> onre �� /, � 3 TIIX CODE IS 3105 TorA� ��3b� I )J <br /> L <br />