Laserfiche WebLink
APPLICATIO� FOR CONSTRUCTf"�N PERMIT �/ <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �(�..�. <br /> �J'.. <br /> BUILDING DEPARTMENT HEATING SYSTEM: !]GAS ❑ELECTRIC �.] <br /> 259-8810 <br /> DEMOLITION I I COMBINATION I I BUILDING ! ' MECHANICAL PLUMBING SIGN <br /> OWNER MAIL DDRE55 CRV 21P PIIONE <br /> KE�n �-�/ F�s�r�t ���D� D/y��1� <br /> TENANT MAIIADDRESS CITV �IP PNONE <br /> �v�� ���r r��� �Yzd� ��3 - 3 �� � <br /> ARCHITECTOROESIGNER MNI�DDRE55� ! CITY ZIP PHONE n <br /> l(iPsr.��e// �e'���!-r� �lC� � `��2 �0'`� �-�� �_a�lt_.Do�Y ��.L-- -��'S. <br /> GENEF�LCONTFACTOR MML�DDRESS CITV TIP PNONE STAT2LICENSEa <br /> �P�� <br /> 1AECNANICAIGONTqACiOR MFIl4DDRESS CITV ZIP PNONE SiATELICEkSE• <br /> PI.UMBMG CONTR�CTOR h141L�DDRE55 CITV 21P PNONE SiATE LICEVSE/ <br /> CONTRACT PRICE OF WORN <br /> � S� <br /> OESCPIBE WORK AND SO FP�FppiAGE INVOIVED CONTACT PERSON AND PHONE NO. <br /> — LC�/�A � <br /> h ` —. <br /> PROPOSEDUSEOFBUILDING I HEREBY CEqTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> APPLICATION AND KNON'THE SAME TO BE TRUE AND CORqECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCPIPTIJNOFPROPERTV�SNOWNBEIOWORATTFdIRYOLOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEPEIN OR <br /> �o.�� NOT. THE GRANTING OF A 'ERMIT DOES NOT PRESUME TO GIVE <br /> e�ocK � oF CGeI•l�, �•LS <br /> y� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ✓I U I . V /6 _ P 7G �'�,o I n'�+i.i5�, OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> LO OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCE!.TF%ID.NUMpER /J APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> ��j - O03- (70.� -(J,�(� CONTRACTORS LAW 182i RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADORESS.TELEPHONE NUMBER �7 <br /> � PROJECT ADDRESS�nv � „�„��4�/ � ��'���� �D/I%�-3 <br /> lJ ir!9/ 'L, o.re <br /> mrvouswcssuccrvscr�o <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC-AiHNDLG UNITS-H.P. <br /> _ BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BAJIN) i UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN � <br /> DISH WASHER RANGE HOOD <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAI� HEAT PUMP <br /> _ BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) � <br /> � <br /> � <br /> � -- <br /> i T <br /> SUB TOTAL $ � SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: ���� �� <br /> fFONTSEiBAGN REMSET9ACK SIDESETBACK PLANC ECKNUM�ER FEE REC[IPiNO <br /> ao a�� �- aai /yG,as ,�s2s <br /> USEZONE LOTqREA VFCANTSRE <br /> `]Sxlyp � FEES VALUATION /F�EE <br /> �- � IJ30_'> .-�. YES i�, . IVU OUILOING /+ i/ i�l.�! � �I+�'{ � y�v ' ,/. <br /> iVPE 0�CONSi. h0.OF STORIES Dtturqnp x0 0�ownuvGurvrts —S�.—!11 !J 7...� <br /> A eaour � p�UMBING <br /> -i`/ � - <br /> SIZEOFBLDG FIRERfHINNLER5RE0'D bFSEMENT MECHANICAL � <br /> _��1� $�, l0 �'-: YES 1�0 — ' <br /> OCCUP4NGYLOAD FlqEql4PMRE00 HEIGHTUMIT�;ION ADDITIONALPLANCHECK . <br /> � a � �� �� OTHER — <br /> REASON <br /> STATE OUILDING SURCHARGE � � �—i l <br /> / <br /> iNTAKE BY PUNSAPPR1O�VEDBV CITY OF EVERETT PU�LIC WORHS T <br /> /�1 Q I J N LOCAL SALES <br /> n�.� �����43 TAX CODE IS 3105 rorn� /�, j �j- <br />