Laserfiche WebLink
APPLICATIP V FOR COIdSTRUCT" 7N PERM9T �� <br />� TO BE COMPLE7ED IN BLACK INK—PLEASE PRINT <br />. ' <br />HEATING SYSTcM: J GAS U ELECTRIC }&S __� I.�—� <br />BUILDING DEPARTMENT — <br />259-8810 <br />'] DEMOLITION :! COMBINATION LI BUILDING i i MECHANICAL �' PLUMBING SIGN <br />OWNER 1.!Ai�ADOPE55 CrtY ZIP PHOYE <br />��na ��»r:;�., 7��7 �����o�v Cn E��:� 'n;�`..��!�%c� ) ��%`1k, _ <br />TENANT MAILApGPE55 qTY ZIV �PH NE <br />ARGMIiECTOR0E5�GNEfi MAILA�DRE55 CITV ZIP FN04E <br />GENERFLCON1R�Ci0F h1A�LF00RE5S CITV 21P PNONE STATELICENSEI <br />� �7 L-�'Qr� f�; �✓�h'�7% `jr'.�LI a57--E��� n� Vini ��: r�'�'>�i l <br />7i:WiV �c�f�C�i_ .. <br />AIEGNqNICAL CONiqACTOR M\IL AOORESS C�TY ZiP PMONE STATE LICENSE d <br />PLUMBINGGONTRFCTOR MaiLA0�RE55 CITV ZIP PHONE STAtELICENSEu <br />COYTRl+GT PPICE <br />�i �� <br />iNV0�9ED <br />n <br />PRJPOSED USE OF BUILOIAG <br />IEGAL OES/CflIPT10N OF PROPERTV ISHOWN BELOW OR ATTFCH iW0 LO/P�IE(S�� <br />lUT—�c-- BLOGh OF ti+--= F`�� � `( 7 <br />�y ii - �,.� <br />CONSTqUCTION LOAN LENDEH. <br />PROJECTADDRE�S : <br />- ono� - onc�/ <br />7 <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) ' <br />84THTU8 <br />Z LAVATORY (WASH BASW) // <br />/ SHOWER ' <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOThIES WASHER <br />URINAL <br />DRI� 1KING FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW PREVENTERS <br />POJF DRAINS—RAINLEADERS <br />S:NK ISERVICE—BAR, ETC.) <br />SUBTOTAL <br />PERMIT <br />TOb�L FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETBACK <br />1 �O� <br />USEZONE LOTAREa <br />iYPE Oi COHST NO.OF STORIES <br />52E OF BLDG FIFE SPRM'LEf15 REO'0 <br />r.� <br />PEASON <br />R�tAKE�Y P1A115APPROVEDA� <br />J I� <br />�,�;E a/�a /c <br />WNiACT PER;ON AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE JAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAIJCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFiEIN OR <br />NOT THE GRANTING OF A� ERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGU! ATING CONSTRUCTION OR THE <br />PERFORM.ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIQN IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTb�1S LAW 78.27 RGW AN4296200 WAC. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A'C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M i <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BJRNING) <br />FIAEPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN / <br />SUB TOTAL S <br />PEFiMIT S <br />TOTALFEE 3 <br />SIpE SETB�CK PLAN CNECk NUM�E(i FEt hp <br />S I � �� /�� • � `l <br />vacnNYESE . /p FEES VALUATIC <br />�'N <br />�� Bl11LDING '� �Z� <br />eac�uz. �io or owewuc urvus <br />�'�0" PLUtABING <br />�-3 I _ <br />BnSEMENT MECHPNICAL <br />❑ VES �O <br />HEiGeru�,urnnoN ADOITIONALFLAVCHECK <br />Z�r OTHER <br />STATE BUILOING SURCHAHGE <br />CITY OF EVERETT PUBLIC WOflNS <br />LOCAL SA:ES <br />rax cooe is aios TOTAL <br />�� <br />FEE <br />—T <br />���� <br />FEE <br />ZJ � <br />� <br />8 <br />T <br />T <br />