Laserfiche WebLink
APPLICATIO� FOR CONSTRUCT�'`N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> ���.. <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> � N ❑ COMBINATION ❑ BUILDING ❑MECHANICAL <br /> MAI�pDDRE55 C PLUMBING �SIGN <br /> WO pTY ZIP p�� <br /> ANT MAILADDRE55 '4� ��n, e/ <br /> � �C IIP PHONE/� <br /> CNITECTORD SIGNER M�ILAbDRE55 �� �// /V/O <br /> CITY 21P PHpNE <br /> GENEMLfqH}qACTIXi M�IL�DDRE55 CITY <br /> � ��fr Z�P P�E STATELICF.NSEIy <br /> 7 M S�b1r 76LS-/fIT Ba.�r /{d.y 13.// .1„ o/���� ��('f�/�� <br /> MECHNIIG ^� _ � u ess ��n. i�--�---'�F��Gl9 �v/ "�4��k <br /> PHONE ST�TE IILENSE� <br /> PWMBINGCONTR�LTOR MAILADDRE55 ��n, <br /> ZIP PNOryE ST�TELICENSEt <br /> CONTRACT PRICE OF WOqK .�I1 <br /> CX=� <br /> DESpq�gE WORK�N SOUARE FOOTIIGE INVOLVED b ��^�L"'V <br /> CONTACT PEPSON AND PMONE NO. <br /> i � <br /> � <br /> PROPOSED oFe�ILDMG � HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> \ APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVpE OF <br /> , LEWLDE CRIPTq10FPpppEq7y�5HqyqBELOWORAiTpCMTWOCppIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � LOT—�.�i+� e�ocK�.c.— oF .�j,Q�� �/��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> /� � AUTHORITV TO VIGLATE OR CANCEL THE PROVISIONS OF ANY <br /> —1•��Z OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTHUCTION.THqT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROpERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTNfI.D.NUMBER APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> � CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTpNIOANLENOER,ADDRESS, LEPHONENUMBER <br /> anaecT�ooness 5��^ 0� g_ <br /> L � � o�re <br /> P��� cr eus�xssiKewserw <br /> MECMANICAL <br /> �. TYPE OF Flf(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILET) �E <br /> BATHTUB � a�—�/�7NDLG UNITS--H.p, <br /> � FORCED AIR SVSTEMS--B.T.U. M E.A. � <br /> LAVqTORY(WASH BASIN) UNIT HEATERS--B.T.U. M <br /> S��R ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILqTION FAN , <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRVTRAY ' WATER HEATER � <br /> CLOTHES WASMER WOODSTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING; � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTEqS ' GAS PIPING , <br /> ROOF DRAINS—flAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> � , <br /> � <br /> SUB TOTAL j � ' <br /> SUB TOTAL $ � <br /> PERMIT S � PERMIT a <br /> TOTAL FEE $ TOTAL FEE S � <br /> FOR OFFlCE USE ONLY: � <br /> FRONTSBTB�LK RERHSETB�CK SIDESETBACK PLANCHECKNUMBER PEE RECEIPTNO. <br /> T �/ // � .3� <br /> USEZONE_ �pTARE� VqCANT5ITE �E$ <br /> VALUATON FEE <br /> ❑ VES ❑ NO <br /> TYPEOfCON57. NO.OFSTORIES BUILDING �(� �� ✓JC� <br /> OCCOV�NCY N6 piOWEIpMGOHrtS <br /> GNWP <br /> PLUMBING � i <br /> SIZEOFBLDG. FIRESPRINKLEHSFEO'U BASEMENT <br /> ❑ YES ❑ NO MECHANICAL � <br /> OCCUPANCY LORD FIRE AURM RE00 HEIGHT LIMITqTION AD�ITIONAI PLAN CHECK i <br /> i <br /> REASON OTHER � <br /> i <br /> STATE BUILDING SURCHARGE � <br /> INTANE BV — � �) �� ' <br /> PLANS API'FOVED BV GTY OF EVERETT PUBUC WORKS � <br /> (J N� LOCAL SALES � <br /> o�re ft�� L,' TAX CODE IS 310S MTAL � <br /> - � <br />