Laserfiche WebLink
APPLICATIOI.FOR CONSTRUCTI�,N PERMIT �����" <br /> mee�P�q•eon TO BE Cf1MPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> everett IiEATING S1'STEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL � PLUMBING SIGN <br /> OW EN IdAILA0DRE55 /-� �, CrtY- \ nZ I r� PNONE y�� /� /� (� <br /> ( �V l ��Jl�i�.Vl�i)�� V lJ-1 � �!Sl' � C 1 Y�I` -1� � f�� PNON��JV .�J��?--ILR�� <br /> iENRNT MAIL ADpRE55 GTV ZIP <br /> �'Ia I'1 K� <br /> ARCNItECTOR�E5IGNER M�ILADOR[55 QTV 2iP PHONE <br /> GENERALCONTRACTOR MAILADORE55 GTV ZIP PNONE LIGENSE� <br /> f�1ov�-�iu...�e�l- .�I I� � i I Av�e . �ue�c N- GS'�1 �ti����l lllcy-fir�!G�/G3��� <br /> MECHANInIC�NL pCONTqACTOF MAIL ADOR[55 CITY ZIP PNONE �ICENSE� <br /> ��ll (LJ <br /> PCLUM�BiNG^LpONTRRCTOR M�IL qODPESS CiiV 21P PMONE UCENSE� <br /> yAE� Il � <br /> G� OF WORrc <br /> NEW . ADDITION ALTERATION . : REPAIR � DEMOLITION �. . WOODSTOVE/FRPL INSERT _- BUILDING FELOCATION <br /> y}{�,s LONTACT PERSON AND PHONE NQO <br /> CONiRACi PRICE OF WOFK`�' ' � V � � <br /> �ESCFIBE WOHn pND SOWRF FOOTRG[INVOLVEO ' <br /> L � --7- l� c�bC. _ - <br /> pnornseousEorsw�ni c , I HERcOV CEfiTIFY THAT I HAVE REAL AND ExAtAINED THIS <br /> � APPLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT.AlL <br /> I"l� � - � �,110,�_)_! �n'LC L ) <br /> iEca�o� aivtio Frnorearvi wnaeiowoanr*ncHFour+corre;,i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS IYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor otcee ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' I AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> II�C � �C��O�-i"—C�� "��� O'OC OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Oq THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TU F:RFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND ' COMPLY WITH THE S�ATE <br /> � Y� /'{('�� �/� _ r�� -�� rG CONTRACTORS LAW 1827 RCW ANO 296.200 WAC. <br /> Lrl t^. �I � +ll -C� ✓� `PU� ��GNATUREOPCONTPALiORORRUtHOPIZE�PGENT DATE <br /> X � <br /> PflOJECiADDRE55 <br /> APPLICANiSCITVBUSME55liCEN5EN0 AND[NSINESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMEN7 FEE <br /> WATER C�OSET(TOIIET) NC—A'HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASHBASW) UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK&DISP i VENTILATION FAn <br /> �ISHWASHER RANGE HOOG <br /> LAUNDP,Y TRAY ; WATEFl HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL � METAL FIREPLACE 8 CHIMNEV <br /> DRINY,ING FCUNTAW FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTEqS GAS PIPING <br /> FOOF DRAINS—RAINLEADEflS EXHAUST FAN i <br /> SINK�SERVICE—BAR,ETC.) <br /> — �— <br /> � <br /> SUB TOTAL $ SUB TQTAL 5 �d ; <br /> PERMIT $ PERMIT $ / <br /> TOTALFEE 5 TOIALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> PRONiS[T[3ACK REARSETBACK SIDESEtOAGK PUNCHECKNUIdp[R F[E RECl.IPTNO. <br /> ..��G 1 � <br /> usezr,Ne �ornaen vaCaNrsire FEES VALUATION FEE <br /> �UILDING <br /> lvv!0�CONiS ALIOWABIE iYPEOiCOHST.PCCUL ocGuo�y.r xa rnUNFuincuwis — <br /> cncw PLUMBWG <br /> SVFOFBLDG. NOAFSTORI[S 9ASEMENT MECHANICAL ���li� <br /> OCCl1PANCYLO�D FlRESi'RNNLLRSPEOD HEIGNTLIMILATION ADDITIONALPLANCHECK <br /> OTHER <br /> uf ASON FOR SPRMKIERS —� <br /> S7AlE BUILDING SURCHARGc <br /> n�u..r rY �'LANSAPPqOVE�BY CITY OF EVERETT PUBLIC WORY.S � <br /> LOCAL SALES <br /> TAX C(1DE IS 3105 torai S.S—��L <br />