Laserfiche WebLink
APPLICATI�''`I FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ) <br /> 259-8810 <br /> I ' DEMOLITION � COMBINATION i I BUILDING 17 MECHANICAL Li PLUMBING I_I SIGN <br /> 0� R MAILADDRESS CI7V 21P PHONE <br /> -E��� �� i flo ��zw fvu�i+�t�' �—'�o/—�l�sab)2�y— 07o b� <br /> TENANT MAILADOPE55 CITV ZIP iT1�NE � <br /> ARCHRECT OR DESIG ER MAIL ADDRE/S�S ' CITV ZIP PHONE <br /> GENERALCONTRA� � MpI�,�RESS �ry � GITY 21P PMONE STATEl.ILENSEM • <br /> Q�h'Q� <br /> MECHANIC..LGONTRpCTOR MAILAODRE55 CIiY ZIP PHONE STATEUCENSE• <br /> PLUMBING CONTRACTOR MAIL ADDRE55 CITY ZIP PHONE SiATE LICENSE N <br /> CONTRACTPRICE WORK <br /> �q .r 2 <br /> DESCRIBE WO N AND SOUAflE FOOTAGE INVOIVED CONTACT PERSON AND PHONE NO. • — <br /> 1� , <br /> �� � S� KE <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED TF 'S <br /> PROPOSED USE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALUESCRIPTIONOFPRGPERTY�SMOWNBE�OYJORATTR nvocoai i WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��� ,,�� � NOT. THE GR.�NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or� BLOCK�f -�L� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFOR�7ANCE Or CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> _, OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELT.IXID.NU aea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � - � CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSiRUCTION LOAN LENDER,ADDRE55.TELEPMONE NUMBER <br /> ��Q�/2�1� /r -�'.Se " �� <br /> � PROJECT A DR SS � oe,e <br /> LI BUSMESStiCEN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HMDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRV TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING� � <br /> � DRINKING FOUNTAM I FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—OAR.ETC.) ; ' <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ <br /> TOTALFEE 5 TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAGK REARSETBACK / SI�ESEiBAC% PLANCNECKNUMAER FEE /� RECEIPTNO. �� <br /> � ' � � <br /> USE ZONE �[ LOT AREA VACANT SITE ,�,� FEES VALUATION FEE <br /> �P„� 2 1T ❑ YES i� rv� gUILDING L(��( � ' J <br /> iVCEOfCONSi. NOAFSTORIES aNvarnv r;oo�mvuuvGUNi15 i <br /> �� °oou° � ��4 PLUMBING � <br /> SIZE OF BLOG. FIRE SPRINKLEAS REO'D BASEMENT MECHANICAL 1 <br /> q9 S.F � ' YES NO <br /> OCCUPANCYLO�O FIREALARMRE00 HEIGNTLIMITATION / ADDITIONALPLANCHECK i <br /> i <br /> OTHER ' <br /> REASON � <br /> STATE BUILDING SURCHARGE i�-(� <br /> INTAKEBY PLANSAPP VEDBV CITYOFEVEflETT PUBLICWORKS � <br /> LOCALSALES � <br /> DATE 3 � S TAX COOE IS 3105 TaT�� � � �� <br />