Laserfiche WebLink
i <br /> -� �w <br /> APPLIC.�TION FOR GONSTRuCTION <br /> PERMIT <br /> rne e�eroreen <br /> H � GTV OF cecrcll <br /> p �x everett rn,� ��,� , e <br /> BUILDING DEPARTMENT 1 � ` <br /> � �y 259•8610 TO BE COMPLETED IN INK- PLEASE PRINT <br /> N � <br /> �y� 1YNER a I-I�er�e,rc� �'-�,��'�D 1 1'l o n r c� �- G���, 3 55- 8��-� <br /> O H O� TENANT AIAILAD�RE55 CIiY ZIP PNONE <br /> 1 <br /> �� �,�P_; <br /> � x AOCHITECfOR0E51GNER AIAILA�OflE55 C�tY 21P pMONE } � <br /> Q �y � G ERILCONiRPGTOP MAILApDRE55 lY 21P PMONE UCENSG• ' �� , �� <br /> � �g �L��.� � -�-�M-d�n��c� 1�1c�L?�i.���✓- , � �S�'i- 5�19�z ; , tr� �. <br /> G�r O MECNRNIGAL JLRACTOR MAILADDRESS CIiY ZIP PIION ���p = �a��^�('• �� � <br /> � y� Vf1-�L�YUC�Ia3 L.�. �-1���-�i � ��� �� <br /> . �, . <br /> PLUM6INGCONIPACTOP MAllP00RE55 C11Y ZIP PNONE LIL <br /> HH <br /> y GLASSOFKVRK `�{/ <br /> ��y ❑ N[\Y ❑ ADDITION d—ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSiOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> � TENNNTIMPPOVEMENiOflINTERION/R�EMOPELION�`{Y CONLACTPERSONPNDPNONENO. � <br /> yHOy CONTNAGTPRICEOFWORK�(���� L� <br /> OESLRIBEWORRRNDSOOAREFOOiAGEIN LVED <br /> PROPOSED USE Oi BUILDIN � ' I �HEREBV CERTIFY TNAT I HAVE READ AND E%AMINED THI$APPLICATION AND <br /> �1� � ��i'�'� � � W - KNOWTHESAMETOBETFUEANDCORRECT.ALLPROVISIONSOF�AWSAND <br /> i.Ec��oESCaivTiorvoFv EPiVISHOWN2ElOWORATiALHfOUNCOPIE51 OROINANCESGOVERNINGTHIS?YPEOFWORKWILLBECOMPLETEDWITH <br /> WHETHERSPECIFIEDHEREINOR NOT.THEGRANTINGOFAPERMIT DOESNOT � <br /> PRESUME TO G:VE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> Lor BioCK OF ANYOTHERSTATEORLOCALLA'NREGULATINGCONSTRUCTIONORTHEPER� <br /> FORM1tANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TNE OWNEfl OF <br /> THIS PROPERTY TO PERFORM THE WOFK FOR W HICH APP�ICATIUN IS MADE <br /> AND I COMPLV �5'ITH THE STATE CONTRACTOHS LAW 1827 RCW AND <br /> 296200 WAQ <br /> SIGNPLUFECFCONiR�Cr' IORAUiMORi2EDAGENi pAIE <br /> „ � Q J��- �• CN�c�c� I��„l�� , <br /> �G �.XI <br /> �qOJECT�OCNES� /� (�� ����� AFPIICANi5CI1V0U5iNE LiCENSE OANDDUSINESSNAME <br /> 1 _7 <br /> (J4./1 I <br /> '�1 PLUMBING MECHANICAL <br /> 1 ' NO. TYPEOFFIi(NPEOflITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> � \YATER CLOSET�TOILET) A/C—A/HNDLG UNITS—M.P. <br /> BATHTUB FORCFD AIR SVSTEh1S—B.T.U. EA <br /> '!' LA\'ATORY�WASH BASIN� _ UNIT HEITERS—E1.T.U. M <br /> 1 ' SHOWER CLOTHESDRVERS _ <br /> � KITCHEh SINKB DISP. VENTILATION FAN <br /> �ISHWASHEF RANGEHOOD <br /> ' LAUNORV TRAY WATER HEATER _ � <br /> ' CLO7HESWASHER _ WOODSTOVE __ . <br /> UFINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> 1 FLOOR DRAIN MEAT PUh1P <br /> ' BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRFINS—RAINLEADERS E%HAUST FAN <br /> � SINK ISERVICE—BAR,ETC.1 <br /> '�' <br /> �� _ <br /> ' _ SUBTOTAI S SUBTOTAL S J`O �� <br /> � PERMIT 5 PERMIT 5 /S � <br /> �� TOTAL FEE S TOTAL FEE S ((7� OU � <br /> FRONTSETB�GN RE�RSQBACK SIOES[T9�GN PIANCNECNNUMBEO FEE PECEIPTNO. <br /> usezorve LOtRPEA vncnr�rsrte FEES VALUATION FEE <br /> n res n r�o <br /> IVPEOFLONST. OLGUPANGYGROUP NO.OFDWELLINOUNITS BWLDING - <br /> n��ow�et��tTu�L p���MBING <br /> SIZCOFBLOG NO.OFSTOR�ES BSMi. OCG.LOAD - ' <br /> n v MECHANICAL �� D� <br /> ❑N - <br /> NEIGMiUMIiAT10N O7NER <br /> fIFESPRINIQEP5RE0UIRED ❑VES ❑NO STATEBUILDINGSURCHARGE <br /> - 1 <br /> STATEENERGVSURCHARGE � <br /> APPUCAIIONPCLOY PLANSAPPN.BY <br /> PUBLIC WORKS <br /> TOTAL �S OU � <br />