Laserfiche WebLink
APPLICATIC-I FOR CONSTRUCT' 1N PERMIT � <br />TO BE COMPLETED IN BLAC;( INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER� /J� MAILRODRE55 CITV � ZIP PHONE <br />/OWt!!� iN.-�CF L G31i rI/k �� �Y��i'if 9�i0i <br />TEN�NT MAILADDRE55 CITY ZIP PHOlIE <br />� <br />ARCMITECiORDESIGNEP MAILADDRESS CITV ZIP PHONE <br />GENERALCONTR�CTOR MAILADDPESS CIN ZIP PHpNE STATE�ICENSE� <br />��lin�e� -- <br />...__._^._^��^^•..�^�•�^ �^^••^��^��� ���r nr PHONE STATELICENSE� <br />PLUMBMGCONTRACTOR MAILADDRESS CITV 21P PHONE STATELICENSE� <br />CONTIiACTPPICEOFWORK N <br />�s00 <br />�ESCRIBE WORK ANO SWANE FOOTAGE 1NVOLVEU CONTACT PERSON AND PHONE NO. <br />L,,�,N <br />FROPOSED USE OF BUILDIN(3 <br />LOT � BLOCK <br />� �� i <br />LOW OR A/TfAGH TWO COPIES) <br />OF ^I�AI�w� �3TI} <br />GL3y <br />` PARCELTA%I.D.NUMBER <br />, CONSTRUCTIONLOANLENDER.ADWiESS.TELEPHONENUMBER <br />I <br />,i PROJECTADDRESS <br />� /�..� �6 a u—t <br />PLUMSINfi <br />� N0. TYPE OF Fll(TURE OR REM <br />WATER CLOSET (TOILEn <br />� BATHT�B — <br />LAVATORV (WASN BASIN) <br />SHOWER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�RAINLEAO <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFflCE USE ONLY: <br />Fi10NTSETBACK � PEAPSETBACK� <br />Z� <br />' USE ZI�.� � LOT �REA <br />.` <br />rree a coxsT. �+o. oF sroaies <br />SQEOFBLIX3. FIRESPRINKLERSREO'D <br />INTAKE BV <br />SIDE <br />�.%wEi/ 29o—S78z_ <br />1 H'cREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIGN AND KNOW THE SAME TO BE TRIiE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO `/IOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOODSTOVE <br />FIREPLACE INSERT <br />HEAT PUMP <br />EXHAUST FAN <br />NUMBER <br />❑ YES � NO BUILDI�G <br />cauwxcr xoaowxwx,uxrts <br />enav pLUMBING <br />BASEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />HEIGN7 uMiTATION ADDITIONAL PLAN CHECK <br />�~ <br />f�i � OTHER <br />� STATE BUILDING SURCHARCaE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAl( COOE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />� <br />—•— <br />N <br />