Laserfiche WebLink
APPLICATIC�I FOR CONSTRUCT )N PERMIT � <br />TO BE COMPLETEG IMi BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: ❑ GAS ❑ ELEC7RIC ❑ � <br />. , � <br />259-8810 <br />!� DEMOLITION � i COMBINATION I 7 BUILDING I I MECMANICAl. �LUMBING I 1 SIGN <br />OWNER MARADDRE55 CITY ZIP PIIONE � <br />`�T.,.c ��Oriiln �e// Ll....� G,i.� .Y/- OQnA/ 2ti O-2i/4 <br />IENRNT MIIILAODRESS ' CT' ZIP PIIOHE <br />�RLHITELTORDESIGNER M�RADORESS CITY 21P P110NE <br />GENERALCONTPAGTOR MAIL�DDRE55 CITY ZIP PIqNE STIITELICkNSE� <br />MECH�NIC�LCp/TR�CTOR MAILA�DRESS CIiV ZIP PIIONE ST�TELICEN9E� <br />� I NEW 1xADDITION y�C,ALTERATION I.l REPAIR L I DEMOLI710N I.I WOODSTOVE/FRPLINSERT f] BUILDRqFELOCATION <br />LONTACT PERSON MID PF.'ONE NO. <br />DESCPRE WJ�M �ND SOU�RE FOOT�GE MVOWED <br />PROPOSEO USE OF BUROM6 <br />tEOAL DESCRIPTION OF FROPEHTY �SNOWN BELON <br />LOT BLOLK OF <br />corrts� <br />0 <br />39// �ava� st �iyd,��r} ' <br />PROJEGT�DDRE55 <br />rwMsiNa <br />Np, TVPE OF fll(TURE OR ITEM FEE <br />WATER CLOSET (TOILET) � <br />BATHTUB ' <br />LAVATORY(WASH BASIN) " �'� �� <br />SHOWER ' <br />KITCHEN SINK 6 DISP � <br />DISHWASHER ' <br />LAUNDRYTRAV , . ,..; <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEA[ <br />SINK ISERVICE-BAR, ETC <br />� SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLV: <br />FfM.k115ETAACK REAR SETBACK <br />USE IONE LOT ARE� <br />1V1'E Of CON15. �LLOWABLE 7VPE pf COMST. �GIIIAI <br />SIZE OF BLIX3. <br />SPRINNLER$ <br />ttJTANE Bv <br />NO.OF STORIES <br />F1RE SPRNKLERS REOV <br />PLANS APPROVED BY <br />r <br />VIICI1Ni SITE <br />I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT, THE QRANTINO OF A PERMIT DOES NOT PRESUME TO fiIVE <br />AUTHORIIY TO VIOLATE OH CANCEI THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINCi CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOii WHICH <br />APPLICATION IS MADE AND I COMPLV WItH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />�n ./� O/1 - - <br />I:�.�N <br />CLOTHES <br />.1 WATER HEATER <br />HEAt PUMP <br />OAS PIPINO <br />BUILDINO - <br />�xcr Mo.aa�ttt�aumte <br />�"0U° PLUMBINQ ' <br />e�SEMENt MECHANICAL <br />HEroHT IMITATION ADDIiIONAL PUN CHECK <br />SPRINKLER <br />STATE BUILDINO SURCHARGE <br />CI1Y OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAI( CODE IS �105 �r�� <br />A.T.U. <br />M <br />8 CHIMNEV <br />FEE <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />