Laserfiche WebLink
APPLICAT101+ F •.� � <br /> ,,,,� ,,�,,,�� TO BE COMPLETED IN INK—PLEASE PRINT <br /> cn v or <br /> e�rerett �HEATING SYSTEM: J GAS J ELECTRIC J � I <br /> Ql__:`!O �_I:l/1e1�,:� 7p <br /> BUILDING DEPARTMENT — �,��„—���v��.sc-- <br /> 259-8810 <br /> DEMOLITION � COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNEB NAi�al)DP[SS CI1V Ti�` PHONE y3S— �JSG� <br /> � u a-��-� `/s�.�j <br /> p A ln Cc� u c. H c �n, i 7 o a 5 [„7 r r� A u N E. R 2 C i a G ro,� w� <br /> i[Nr1Ni MqLA�ORE55 LITY 21P PNONE <br /> I/� cAnl i <br /> n�1�,�uIELTOR�E5IGN[R MAILApDRE55 QT� 21P PHONE <br /> iti, ' i�' cQ �ESIGNE� <br /> .yp�.�� G[11LRALCONTMCtOR MRIlR00RE5S CITV ZiP FHONE UCENSF.• <br /> l'] <br /> ay <br /> .O'rUCZ NfCHANICRLGONtRACTOR MAILADDHE55 CiTV 2iP PHONE LICENSE� <br /> aH <br /> ym <br /> r "�> PW6iDiNGCONiRACTOR M4ILROORE55 CIiV ZIF PHONE LICENSEI <br /> y Y,r�i <br /> � H�f <br /> Q ASS OF YlORK <br /> � y� NEW . ADDITION �'ALTERATION REPAIR DEMOLITION WOODSTOVFrFRPL INSERT .. BUILDING RELOCATION <br /> ^'� �1 C/CN'iACi PERSON RND PMONE 110 V <br /> � 'Y.� �ONiPRCTPRICEOFWORH �p( O � �/ l OAIO /e F ��✓ �• N � / N �� S—7 &� o <br /> y� C[SCRipEWOPK�ND500RREfOOTG[MVOLVEO <br /> OH <br /> H �g vnOPOSEDU5EOF0ULLOMG I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> f,]• O APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �"� PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS NPE(1F <br /> � y t[WlDESCRIPT�O'lOFPRO�'EAIV�SHOWNBELOVlORRiTAC11i0UFCOPIE51 <br /> u` � UE,C�G l"�vORK�VILL BE GOMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> x ior V-uZ _ ���K _!_!�- �F NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GI�E <br /> �y H y AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> pN�.-� ����i ��M t � ,�A�F 3 a OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> C] C7 V� PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � �r OWNER OF THIS PROPERTV TO PERFORh1 THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I GOMPLY WITH THE STATE <br /> x H V1 CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br /> H O V1 J��O•J,1iLREOFCONfRACTOROP�ULHORIZEDAGENi DATE <br /> PnOI.'.GT PDDR[55 — — � �-- �"-�—�--t • /—�-- <br /> 41'PliCt•HiSfIiV(11151!.ESSUCENSC�:OAN�OUSItiE55N E <br /> ' `32c� � . - .=, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ��' WATER CLOSET ITOILET� /(J ' A C-A HNDLG UNITS-HP. <br /> �� a BATHTUB J ; POFCED AIR SYSTEMS-B.T.U. 61 EA. <br /> LAVATORY(WASH BASIN) /J� UNIT HEATEFS-B.T.U. M ; <br /> -� <br /> 'w� _ SHOWER CLOTHES DRYERS 1 <br /> �� KITCHEN SINK 8 DISP VENTILATION FAN _�_ <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ,� ; WATER HEATER <br /> CLOTHES WASHEF � WOOD STOVE _ <br /> � '� UFINAL ME?AL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE 14SERT _ <br /> '�� _ FLODR DRAIN _ HEAT PUMP <br /> �I,I BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINH(SERVICE-BAR,ETC.) _ <br /> 's � <br /> T <br /> !�� <br /> I I S�JB TOTAL 5 - SUB TOTAI 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE 5 S �- TOTAL FE[ S <br /> ' FOR OFFICt USE ONLY: <br /> �RGNTSEI�ACK R[AR;EIOACH SIDESEiBRCN PI�NCHECNNUMBEB FEC RECEIPTNO <br /> usi 7or+e �or anea VACRNTSI7E FEES VALUATION FEE <br /> UUILDING �LOQO [� ' OJ <br /> h�'f 01 f.ON15 PIlOWAOI[ LYPE Of WNiI AC7UAL x[ov�ncr xo w onuubsub���s — ) — <br /> �"°°3 � PLUAI�ING ; UJ <br /> ys <br /> 64E OF BIOG NO Of SiORiFS BFSEMENT IdECHANICAL <br /> � J � — <br /> ��ccuanNcvlon� FinESPnNKtEnSaEo'D ��EiGHrubmnnar� �ODITIONALPLANCHECK ; <br /> NlA N' _ oTxen � <br /> ;n aso��ron srnir�ei[ns <br /> STATE BUIt�ING SURCHARGE i v(�� <br /> rt�in�r iv - � - � vuNsnPrNoveoor CITY OF EVERETT PUDLIC WORKS ' <br /> � LOCAL SALES <br /> b>Z� TAX CODE IS 3105 TOTAL �n.�/ � ,�O <br />