Laserfiche WebLink
APPLICATION�FOR CONSTRUCTI�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM. GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION I-I BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN <br /> ���c�rut, Mar r�p0�-4 3a� �ltc��h��Z�PI�,d �H�� 78d0� a5�r- 3� <br /> TENANT�^ MAILADDRESS CIN ZIP FMONE <br /> Y 11� <br /> ARC�CTONDESIGNER WRADDflESS CITY 21P PNONE <br /> � `� <br /> GENE�COJlT�Ofl M�RADDRE55 CITY ZIP PHONE STATEUCENSE� <br /> 1 <br /> MECNNIICALCONT TOP MAILADDRE55 QTY ZIP PHONE ST�TELICENSEf <br /> n,��. � <br /> PjUMBIN(3CONTMCTOR MAILADDRESS CITY ZIP PHONE STATEIICEN5E1 <br /> . A` <br /> 1 1 <br /> Cq �CT PRICE OF WORN <br /> , <br /> DESCRIBE M/ORN AND SOU�RE FOOT�CE INVOLVED CONTRGT PERSON RND PMONE NO <br /> �u� � r n <br /> �'� I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br /> rao�SeojLSE'QM1@UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �--,i PROVISIONS OP LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LECW DESCRIPTKK/OFPROP�FTY�SHOWN6ELOW ORATTACHiWOCOP�E51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT ewcK oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE GF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PAqCELT(J(�.D.NUMBER CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADDRE55.TELEPHONE NUMBER <br /> X-��,vk� �-�/ �' 7/93 <br /> , �(\�G(!T�/�AR $IGNAIUR DATE - <br /> —r�•^c r� / <br /> `� j ��'I17 L�TYBUSMESSLICENSENO <br /> PLUMBINQ MECNANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EUUIPMENT FEE <br /> WATER CLOSET(TOILET) A/�ArHNDLG UNITS—H.P. —r— <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BA.,IN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN ; <br /> � DISHWASHER . FANGE HOOD � <br /> LAUNORY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL �AETAL 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.) ; ' <br /> � <br /> � � <br /> � � <br /> , <br /> SUB TOTAL S � SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSEiBRCK SIDESETBACK PLANGHECKNUMBE7R fEE RECEIPTNO. <br /> C� <br /> USE20NE LOTARE� VAC�NTSITE FEES VALUATION FEE <br /> rl YES i, NO BUILDING <br /> TYPEOfCON51. NO.OFSTORIES oCtuo�x[r NOOfOV/Fll�N4YNii5 � <br /> �"�° PLUMBING <br /> S2EOFBLDO. FIRESPRINNLERSREO'0 BFSEMENT MECHANICAL <br /> C: YES NO <br /> OCCUPANCVLOAD fIHEAURMREQ'0 HEiGHTLIMIT�TION ADDITIONALPIANCHECK � . <br /> i <br /> i <br /> OTHER • � <br /> flFASON <br /> STATE BUILDING SURCHARGE i <br /> INT�KE BY PlANSAPPPOVED Bv CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> oA,e TAX CODE IS 3105 TOTAL � <br />