Laserfiche WebLink
APPLICATIO� FOR CONSTRUCT(` i�l PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENI�„ / HEATING SYSTEM: .J GAS J ELECTRIC J <br /> 259-8610 � <br /> f1)in <br /> I_'. DEMOLITIO �.�i] COMBINATION I I BUILDING L]MECHANICAL ❑PLUMBING ❑ SIGN <br /> ONTIER MR/' O/JC�X �� Ci�� Z/�I/Z PHON6 S�—���� <br /> �r1AM�l�t� . - <br /> TENRNT MFII.FDDR[SS GTY LP PMONE <br /> ARCHITEGTORDESIGNER MAILADORE55 CITV Z11` PNONE <br /> aENERAL CONTRACiOR IARIL ADDRESS CiT\' 21P PHONE STATE LICENSE� <br /> I MECMnNIGAL GONTRRCTOR MAIL ADDRESS CIN ZIP � PHONE STFTE IICENSE t <br /> PWMBINGCONTRACTOR MFILADDRE55 GTY ZIP PHONE STATELICENSEY <br /> CONTflALT PRICE Of WORK <br /> DESCRIBE WORK AND SOUARE FOOTAGE INYOLV ` /r CONTALT PERSON AND PHONE NO <br /> � '��� <br /> Isi �J �L 04. �M`At <br /> V i H[REBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> GROPOSEOUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL • <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SMOWNBELOWORATfACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHEtNFR SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior — eiarc— oF AUTHORITY Tfl VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFi THE <br /> ' — ` � PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWIJER OF THIS PROPERTV TO PERFORM THE WJRK FOR WHICH <br /> - _-- . -- APPLICATION IS MADE AND I COMPLY WiTH THE STATE <br /> Pnace�raz i.o.rvuMee�a CONTRACTORS LA 7 RCW AND 296200 WAC. <br /> CONSTRUGTIONLORNLEN�EP.ADDRESS.TEIEPNONENUMBEH w � <br /> X <br /> 0 /� <br /> ECT � � s�c,e�wn� n.rc <br /> cuv eus+rtss ua nse r�o <br /> PLUMBING MECHANICAL <br /> . N0. TYPE OF fIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AiC—A'HNDLG UNITS—H.P. T— <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> IAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHUWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br />, DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CI.OTHES WASHER WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) <br /> DfiINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPIIJG � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN �— <br />, SINK(SERVICE—BAF,ETC.) <br /> I ' <br /> � <br /> SUB TOlAL $ SUB TOTAI $ <br />� PERMIT $ PERMIT S � <br /> TOTALFEE $ TOTALFEE $ � <br />' FOR OFFICE USE ONLY: <br /> FRONT SETBFLY, REAN SETBACK SID[SETBACN PLAN CNECK IJUMBER FEE PECEIPT N0. <br />� useior+e iornaen VACHNTSItE FEES VALUATION FEE <br /> �� .: YES �' NO OUILDING <br /> iVPE0fWN5i NOOFSTORIES acu�/vcr xonrDWiwri,r,xi*5 <br /> 'A"�0� PLUMBING � <br /> i <br /> SIZE OF BLDG. FlRE SPRINKLERS REO'D BASEMENT MECHANICAL i <br /> C VES �: NO <br /> OCCUPANCY LOAD FlRE ALARId flEOD HEIGHT IIIAITATION ADDITIONAL PLAN CHECK <br /> O7HER <br /> FEASON -- — --r— <br /> STATE BUILDING SURCHARGE ; <br /> INTANEBV PLANSPPPROVEDEY CITYOFEVERETT PUBLICWOFNS ' <br /> LOCAL SALES <br /> oa.e TAX CODE IS 3105 rorn� <br />