Laserfiche WebLink
APPLICATIO' FOR CONSTRUCT!"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: x1 GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> Ci DEMOLITION f 1 COMBINATION I J BUILDING X MECHANICAL Li PLUMBING i 1 SIGN <br /> OWNEF �^ MFIL�DDFFSS CITY ZIP PHONE <br /> �pR✓dULL/VfJ� eJ0�7SDAKE"$ {./VE F✓E7�t�t' �1�T�0/ o�STs'-LnOL D <br /> TENANT MAIL�DDRE55 CIiY Z�P PHONE <br /> ARCHRECTORDESIGNEA MAILFDDRESS CITV ZIP PMONE <br /> GENcPFLCONTRACTOR IAAILAOORESS CI7Y 21P PHONE STATELICENSE• <br /> MEGHANICAL CONTRFCTOR MAIL ADDRE55 CITV 21P yo�j� PHONE STATE UCENSE� <br /> O <br /> .Z>��.qcE�✓�ecYSrSrr-rns i99ai -��/rn/�vr- uJ ,�XN�✓..�ono ���t-8.3i,s Ter-79LESo6�.7'/� <br /> PWMBINGCONTRACTOR MAILAODRESS CITY ZIP PHONE STATELICENSEa <br /> CONTRA PRICEOF\VORN �� <br /> �/ � U � - <br /> DESCRIBE WORK�ND SOUPRE FOOTAGE INVOLVEO GONTACT PERSON AND PMONE NO. <br /> T <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOPPFOPEPTV�SNOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH!CH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STAT� <br /> PARCEL TA%ID.NUMBEfl CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> a`j•�9- ai - oo ' <br /> CONSTRUCTIONLOANLENDER,ADORESS.TELEPHONENUM�ER <br /> x_Q_.!_.�_t.L---L� y-.;9-9a _ <br /> PROJECT ADDRESS s�cnnruae�s?7/�� onie <br /> arv nusrt+[ss uci r�se No <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OP E�UIPMENT FEE <br /> WATER CLOSET�TOILET) A!C—AMNDLG UNITS—H.P. � <br /> BATHTU� FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> �AVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHESORYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> • LAUNDRY TRAY ; I WATER HEATER <br /> CLOTHES WASHER � W000 STOVE � <br /> URINAL ; METAL 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 /> T <br /> 1 <br /> SUB TOTAL & ' SUB TOTAL 5 ' <br /> PERtdIT S � PERMIT 5 ,5� � <br /> TOTAL FEE S TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK PEAR SETOACK SIDE SETBALK PLAN CHECK NOMBER FEE RECEIPT N0. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> T <br /> ❑ YES �� ' N� BUILDING <br /> iVPE0FWN51. NO.OFSTORIES otturn5tt hJOrOWnuHGuxnS � <br /> taouP PLUMBING i <br /> SIZE OF BLDG. FIRE SPPINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ YES f� NO — -- <br /> OGGUPANf,V LO�D FIRE ALAR61 PEQ'D HEIGHT LIIAITATION ADDITIONAL PLAN CHECK i _ <br /> OTHER � <br /> REnSON � <br /> STATE BWLDING SUFCHAflGE <br /> i <br /> INT�HEOY PLANSAPPRWEDOV CITYOFEVERETT PUOLICWORKS <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 rorn� � <br />