Laserfiche WebLink
APPLICATIC^1 FOR CONSTRUCT"lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC O <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING I�'FAECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADDHE55 CITY ZIP PHONE <br /> ���1..+�� �2l,DcPY Il2'��xvc�ur"2 CUr"¢c7f 982a1 'LSZ -.s�h94� <br /> TENANT MAILADDRESS CITV ZIP PHONE <br /> ARCNITECTORDESIGNEH MAILADDRESS CITY ZIP PMONE <br /> GENERAL CONTRRCTOR MAIL ADORESS CITY ZIP PHONE STATE LICENSE/ , <br /> EURoR� 2�i�� a6�a, W EOhauns `iPeto 7��-0�-7� F_v,¢otr�a�o,v <br /> MECHANICA�CONTRACTOR M�ILADDRESS CITV ZIP PNONE ST�TEUCENSE� <br /> PLUMBINGCONTAACTOR MAILAODRESS CITY 21P PHONE STATELICENSE� <br /> #i�[JD DD <br /> C04TRACT PPIGE OF WORK <br /> DES RIBEWORKANOSOUAHEFOOTA6EINVOLVED CONTACTPERSONANDPHONENO. <br /> A(kL• .0 �' e+� <br /> � I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> ' PROPOSEUUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEW.DESCRIPTIONOFPROPERTV�SHOYMBELOWGRATfACNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR . <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOFiK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.O.NUMBER CONTRACTORS LAW 1 .27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOaN IENDER.ADORESS,TELEPHONE NUMBER � <br /> z x � • 1 • !G •S3 <br /> �� PROJECT ADDRESS san—� a�� o�re <br /> CI1Y BUSME55 ULENSI NO <br /> ' PLUMBING MECXANICAL <br /> Hp, TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILE� � PJC—NHNDLG UNITS—H.P. � <br /> ' BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � _ LAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M � <br /> SHOWER ' CLOTHESuRYERS ' <br /> � KI?CHEN SINK 8 DISP � � VENTILATION FAN T_ <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> . CLOTHES WASHER WOOD STOVE _T <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> ' DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN � HEAT PUMP � <br /> � BACKFLOW PREVENTERS I GAS PIPING _� <br /> � ROOF DRAINS—RAINLEADEflS � EXHAUST FAN r <br /> SINK(SERVICE—BAR.ETC.) � � <br /> , � <br /> T <br /> 1 � <br /> 1 � <br /> 1 � <br /> I <br /> SUB TOTAL S ' SUB TOTAL $ �_ <br /> PERMIT $ � PERMIT $ / � <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBALK RERRSETB�CK SI�ESETBRCK PLANCNECKNUMBER FEE Pf:CEIPTNO. <br /> USE ZONE LOT�REA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> flPEOFfONST NO.OFSTORIES otavexCY NOOfRAEuiNGUNus � <br /> �wWv PLUMBING i <br /> SIZEOFBLDG. FIPESPRINKLEFSREO'D B�SEMENT MECHANICAL � <br /> ❑ YES G NO � <br /> OCCUPANCY LOAD FIRE AURM REO'D HEIGHi IIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER � <br /> REASON <br /> STATE BUILDING SURCNARGE i <br /> � <br /> INTAKEBY PLANSAPPROVEDBV CITYOFEYERETT PUBLICWORKS <br /> LOCAL SALES , <br /> opTE TAX CODE IS 3105 TOTAL � <br />