Laserfiche WebLink
1 <br /> --� �� A►�PLICATI� FOR CONSTRiJCT:~'�N PERMIT � <br /> �� TO BE COMP�ETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: C.1 GAS � ELECTRIC :J � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> ^'�.. � OWNER . � MAILRD�RESS � r GiY J � 21P PHONE 1 / I <br /> � ,' �11.�.<y '.�"iklc"hC '.,/�� �L�ir�idi' %�7� ; .it,� Jfi?y j��l"�/7� <br /> � TENANT 1ARILRDDRESS CItV 2iP PHONE <br /> AR�NRECiORDE5IGNER MRILAD�RE55 CITV LF PHONE <br /> GEryERPLCONTRACTOR MAILA�DRE55 QSY , Z�P PNONE STATELIGENSE• , <br /> �t�3� (�i;�n, G/,��1:%fi.l5 :-% 1,;%>'� //S�, ��,-Y�(/ `11�,>i 1�li ��Y%`: C'C�:T'E/5"ff/ <br /> MECHPNICALCONTRAGT R IAAILRDDRE55 GITY ZIP PHONE STRTEIICENSE� <br /> ay <br /> C��H GtY 2iP PHONE STATEIICENSB• <br /> ayy PLU��BINGGONTFAGTON MF!LADDF[55 <br /> y �H c�nss oF waryc , <br /> K y.�ny NEW ���.�DDITION ALTERATION REPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br /> CONt4Gj PEASON ANO PHOH[NO <br /> � y� 7 l�6 — :,�y_ /3S7 <br /> CONTRACTPiiICEOFWORN (��`� I/ //�( � <br /> x Z DES�'�OPNANOSWAAEFOOTAGEINVOLVED � <br /> H <br /> [�7 p� � ., /.t� clrZ��'�: rr 7;,� � c �� lt,� 'r ,�;Y'����t'u: <br /> y -�Ci� i HEREBY CERTIFV THAT I HAVE READ �ND EXAMINED THIS <br /> p� ��y raoaoseou eoveuaoir+c _ �`�S� qppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � L'7 O G'i���'���' /�"�/����'�� �'���+�/�!�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> N G LEGALOESLFIPTIONOFPROPERTVISHOWN9ELOWORATTALNFOURCOPIES� yyORK WILL BE COPdPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> y+ H 3 �or ��� etocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRES164E TO GIVE <br /> � �7 Z � � AUTHORITY TO VIOLATE OR CANGEL THE PROVISIJNS OF ANV <br /> H y � �,f- ���C�t��W� OOS� OTHEF STATE OR LOCAL LAW REGULATING CONSiRUCTION OR THE <br /> � p7 PERFORMANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BV TNE <br /> bN �rnC�Q����a,_ I� UJI OWNER OF THIS PROPERTV TO PERFORId THE WORK FOR WHICH <br /> C�' K�� APPLICATION IS MADE AND I COMPL�' WITH THE STATE <br /> `"� CONTRACTORS LAW 18.27 RCW AND 296.200\4'AC. <br /> H o vi Y �//%e`�r�'/� �ci��I, %'',, i't`l.�" <br /> ��^ � ,�y -�,j <br /> PROJECi RODPE55 �� r / - � � �L `,(✓.) ''7,J ---"- <br /> i <br /> �I�1>S� ��/I`��"�uC!'� LYr• C .flC� a..nucw�csocrr:st.a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) — A�C—A'HNDLG UNITS—H.P, _ <br /> � � FORCED AIR��VSTEMS—B.T.U. M E.A. <br /> BATHTUB <br /> !' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M _ <br /> SHOWER ' — � CLOTHFS DRYERS <br /> � �. KITCHEN SINK 8 DISP VENTILATION FAK . <br /> ' � DISHWASHER RANGE HOOD �� <br /> LAUNDRY TRAY — WATER HEATER . <br /> CLOTHES WASHER � �— WOOD STOVE � <br /> � URINAL METAL FIREPLACE 8 CHIMNEV <br /> �! DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUA1P <br /> ��' ' BACKFLOWPREVENTERS GASPIPING <br /> Y <br /> ROOFDRAINS—FAINLEADERS EXHAUSi FAN <br /> SINK(SERVICE—BAR,ETC.) — <br /> U. �' i <br /> (� <br /> ... ,� <br /> ' � SUBTOTAL 5 �� �' SUB?OTAL 5 s0 ' — <br /> I I PERMIT 5 PERMIT 5 <br /> -- TOTALFEE 5 TOTALFEE 5 _ <br /> FOR OFFICE USE ONLY: �� ''� <br /> RECEIPiNO <br /> • FRONTSEiB4CK REA�iSEiDACK SIpE:ETBACN CLANCNECKNUMOLF FEE <br /> .�5 , _ — -� . � ' 3� s /7l `� 7 <br /> useior+� �oTnr+en y. WLRNi51tE fEES VALUATION FEE <br /> '- S 17 I�OC� -= NO BUILDING � 3Y 9 �s-o <br /> LrPfOlLONISAILOWABIF IVPiO�LON9.AG1U0.l a.ure�tr xoeiw:uu'.c�u�is ' <br /> caouo pLUMBING ��00 <br /> ;iZj/�oIDG �D� NooFSTo� BaSEM 1 MECHANICAL j d ' O� <br /> 9 S' J /-� <br /> OCCUPANGVlOAO FiR[SPRNNLERSHEO'D NEIGMTUMITAiION <br /> — ADDITIONAL PLAN CMECK �. J V �7/ <br /> �(J SPRINNLER _�_ <br /> REASON ORS�qINNlEPS <br /> STATE DUILDING SURCHARGE 'S� <br /> ,,,TAKcuY PlF�ISAPPROYLUOY CITYOFEVERETT r�uuucwonKs <br /> LOCAL SALES <br /> 3� Z TAX COOE IS 3105 rora� �/5"J`� � �/ <br />