Laserfiche WebLink
APPLICATIC 1 FOR CONSTRUCT- IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATINGSYSTEM: L]GAS OELECTRIC <br />BUILDING DEPARTMENT <br />259.8810 <br />1 , DEMOLITION U COMBINATION LI BUILDING ❑MECHANICAL )(PLUMBING (i SIGN <br />CITY P? PRUNE <br />Owr , .+ MAL ADOIIESS . I .. r ;) 'CI - PA B D . L. J 77P44 <br />:E <br />WLAOGRE53 <br />CITY <br />M <br />°E'LML <br />r A, <br />ARCHITECT OR DESIGNER <br />W%ADBRESS <br />CITY <br />M <br />T>� <br />GENERKCONTRACTCA <br />WLADORE55 <br />CITY <br />M <br />PIIOHE STATE LCFNSE• <br />MECNANCAL CONTRACTOR <br />MAIL MCMM <br />Cltt <br />M <br />"NONE STATE LICENSE! <br />IUMBW CWTRACTOA <br />MAI. D ECS <br />CITY <br />M <br />P Nt SUM LCENSE1 <br />C TRACT PRICE U WQl4 <br />DE flME XCIX AILEFWiARE VED <br />C tACtP R P11lWE NJ. <br />2tpr4ino A/61 <br />i'rr EAN <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMI,.ED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />euLDnG <br />TnwsEousEo <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />SPECIFIED <br />WORK L L BE REIN OR <br />WITH E <br />of PflCPERttLSI1DMI BELowoR AtTACR TWO 'EST <br />LEaucescRlvrloN <br />SUME ESUMETO GIVE <br />NOT THE GRA TANG OF ADPERMIT O SNOT PRER <br />Lot BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR NCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC TION IS MADE AN 1 COMPLY WITH THE STATE <br />CONT TO LAW 18.27 RAND 296.200 WAD, <br />/� n <br />PARCEL TAX I D NLINeER <br />CONSTRUCTONLWNLENOER. AODRM.T LE IENWBER <br />1.31 r, , <br />/6 <br />PROJECT ADDRESS <br />N <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FI%TU RE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATERCLOSET(TOILETI <br />(DI <br />A'C-AHNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIRSYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHESDRYERS <br />KITCHEN SINK E DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE H000 <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />—T <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUB TOTAL <br />f <br />SJo I <br />SUB TOTAL E <br />' <br />PERMIT <br />S <br />p0 <br />PERMIT E <br />TOTAL FEE <br />E <br />7 <br />TOTALFEE E <br />run urrmr LAaIa <br />A,n�.. <br />SIDE EEIOACK <br />PINT CRECR MJURER <br />fFE <br />RE[EIPi NO. <br />ENCN16Et8AC4 <br />REMSEt8AC4 <br />053 <br />UFE mNE <br />LOT MCA <br />vALAItt SITE <br />FEES <br />VALUATOR <br />FEE <br />BUILDING <br />❑ YES ❑ NO <br />TMIi CONS) <br />NO a81(IR4s <br />mna+ Wndlul,Lur•L <br />Meu <br />PLUMBING <br />SRE aFBLDO <br />RRE"INKLETLSREDD <br />BASEMENT <br />MECHANICAL <br />' <br />--�'— <br />❑ YES C, NO <br />oCCUPANCYlWO <br />FNE AIATBIMOD <br />IIEIONTLMRATM <br />ADDITIONAL PLAN CHECK <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAXEBY <br />TRANSAMMYEDer <br />CITY OF EVERETT <br />PUDLIC WORKS <br />' <br />LOCAL SALES <br />TA% CODE IS 3105 <br />TOTAL <br />ogre <br />