Laserfiche WebLink
� APPLICATIC"'1 FOR CONSTRUCTiN PERMIT <br />TO BE COMPL�TED IN BL.ACK INK—PLEASE PRINT � <br />V�"" <br />BUILDING DEPARTMENT f HEATING SYSTEM: J GAS ELECTRIC ❑ <br />259-8810 <br />I-1 DEMOLITION � l COMBINATION <br />MAI� <br />•C <br />BUILDING I i MECHANICAL [_l PLUMBING Cs: SIGN <br />CITV / ZIP PHONE ���� 2I _] d p-� <br />T[NANT �J MAIL�ADDFE55 GTY 21P PHONE ' <br />�— �/j � <br />FRLHITECT OR OESIGNER MAR qpDRE55 piY ZIP PMONE J <br />��S/G G//I/�S, /dc.�/-'%/S/'�s.1/>�so�'✓�rY/EA,E7`T GG%� 9�2o3-S3sG/ 353-033) r <br />GENGqALCp'IiRACiOR MARqpDPESS LITY ZIP� � PHONE S TEIiCENSE� I /1(a+I?r• <br />9/f-S%/�,7 C'C�/S70y///CT//i/C/�2�c}�-fS�, 9" �_/�//E�}'t_?l�ll�Q„9rr�o5�3�7-s/Gitl���'i-iw.n' <br />h1EC11ANiCAICONiRAGTOR NAIIAD�RE55 � QTV 21P � pH0 5T IIGENSE• ���T <br />PWMBINGCONTRqLiOR MAILADDRESS �ITY 2iP PIIONE STFTEUCENSEt <br />CONTNACT PqICE OF WOPK ��_$"'£`% —��3 f' ��O <br />DESCR!BE WURN qN0 SJURRE FOOTAGE INVOLVEO <br />PflOPO5E0 USE OF BUILUING <br />��S'/.17F✓I/ T/�7L <br />LEGAL pESGRIPTION OF PROPERTY �SNOWY BELOW OR ATTACN NJO CGPIf S� <br />LOT� BLOCK OF ���_ <br />��f__i9TTfJ�iS'E'�7 <br />PARCEL TA%I D. NUMBEfl <br />CONSTRUCTIONLORNLENDER.ADDRESS.TELEPHONE <br />� <br />TYPE OF <br />WATER CIOSET <br />BATHTUB <br />LAV/.iORY (WASI <br />SHOWER <br />KITCHEN SINk: S <br />(�r-3 <br />OR ITEM <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />RGOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAF. ETC.1 <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT�C% REARSETO�/ <br />USE NE �pTAqEA <br />� �� <br />iYCEOiCIlNSi. NOAF�ST7OHIFS <br />�� ` <br />S2EOFBLUG_� , FIRESPqINKLER5RE0'D <br />N /p � <br />RE/SON <br />P.iAKEOV PLANSAP RO\"ECBY <br />� �� <br />UATE L/�;,: �/q3 <br />SIDE SEiP4f�/ <br />� <br />CONTACi PERSON qND PHONE N0. <br />i HEREBY CER-fIFY THAT I HAVE READ AND EXAMWED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIFD HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEfl STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH <br />APPUCATION IS MAGE AND I COMPL`/ WITH THE STATE <br />CONTRACTOqS tAW 1827 RCW AND 296200 WAC. <br />TYPE OF EOUIPA <br />A/C—A/HNDL(i UNITS—H.P <br />FORCED AIR SYSTEMS—B. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGE HOOD <br />METAL FIREP_ACE <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />'rYES i"'', NO <br />OUILDING <br />orxu�.�.:� naanvmrvcu�ms <br />�"o'� "'L pLUMBIRG <br />BASEM MECHANICAL <br />ES ❑ NO — <br />NBG�rt uMrtAnor� AODITIONAL PLAN CHECK <br />ZB � OTMER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOriKS <br />lOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />I:i�:15111 <br />F[E <br />�/l �% <br />E.A. <br />—i— <br />RECE,IP�i'NO <br />- -L�� <br />FEE <br />r <br />� r. <br />�J� ; >/ <br />/ i <br />/ r.lL i /J17 <br />; ,� > <br />� <br />� <br />