Laserfiche WebLink
APPLICATIQ��' FOR CONSTRUCT'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM:�GAS J ELECTRIr J � <br /> BUILDING DEPARTMENT —� <br /> 259-8810 � <br /> DEMOUTION : COMBINATION BUILDING ' i MECHANICAL i��P'LUMBING i SIGN <br /> OWIlER /� MAILADDRE55 UTI ZiP PMONE <br /> �� � ��u ��� 71.�� .���__.. '��� �f � <br /> �i�•r. , I� i )11�1 r �� � ( I �1_.a�. l� l�. L�1,� u - <br /> iENANt r , MRRADORE55 pTV 21P PHON[ <br /> �L�/y�L <br /> /.RGHRECTOROES�GNER GAILADpRESS CITY ZIP PHONE <br /> GENERRLCON:FACipR MAILAODRE55 CITY 21P PHONE STATEIICENSE � <br /> n�� ;a�1�- n_II �j� � �9.����, I r2n;(�`�K�" �EP,-�61�'1 ?y,�_.�I7c c , � <br /> MECHANIC4LCONTRACTOR hIPILAD RE55 pTY ZIP PHONE ,,1 STATELICENSE� <br /> C•,�fi'1 � /`�(�)r�l f1 !.l;r������% <br /> PIU�ABiNGCONTRACTOR� MA�LAD7RE55 CIIY ZIP PNONE STATELIGENSE• <br /> M <br /> CONTqACTPRICEOFWORK�� , `� �� <br /> DESCRIBE WORK ANO SOURRE POOTAG[IN\'OLVED CONTACT PERSON PND PHONE NO / � <br /> ��r�;r�gN�t,r> <br /> i .�v�lAtc - YLFi A� /i(� /I��r.� -.,�� '1����(� S�' X `tt � <br /> � � <br /> I HEREBY CERTIFV THAT I HAVE READ AND EKAMINED THIS <br /> aaoaoseouSeoFaw�oiNc � APpLICATION AND KNOW THE ;AME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7HIS TVPE-OF <br /> �ecn�oescaiPnoNOFanovearv�sNowNse�owoannacHnvocoaiesl WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT e�cea oF AUTHORITY TO VIOLA7E 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 /> O1vNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> APPLICATION IS A FLY WITH THE STATE <br /> anace�rnx i o.r+uueea �� � � _ "� CONTRACTOR 78. D 296. 0 WAC. <br /> �r��J � T �- ��.��(_1C '�� <br /> CONETPUCTIONLOANLENDER.FDDRESS.TELEPMONENUMOER ` / � <br /> L <br /> PROJECT ADDRESS �_ scr++ruei ie <br /> �7� � � � � � � I��� � � ��� cnvouSv�ssucE,sino _ <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A'HNDLG UWITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.0 E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> SHOWER CLOTHES DRVERS —T <br /> KITCHEN SINK 8 DISP VENTILATION FAIJ <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> UflINAL METAL FIREPLACE�WOOD BURNING) � <br /> DRINKING FOUNTAIN PIREPLACE INSERT I <br /> T <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENT'eR5 GAS PIPING /� '' ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETG) �— <br /> i _ <br /> SUBTOTAL 3 �UBTOTAL $ <br /> PERMIT S �— PERMIT $ <br /> TOTAL FEE S TOTAL FEE 5 r` �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REFRSETORCK SIDESET�ACK PLI.NCNECKNUMBE FE[ REGEIPTNO. <br /> �v;�a� <br /> use 1or+e �or aneq VACANT SIiE FEES VALUATION FEE <br /> i .' YES .-'': NO BUILDING <br /> lYPEOiCOHSi. NOOFST�PIES oG<vnxC� xOmmi.Wuemeb i <br /> �no�rr p�UMBING � <br /> SIZE OF BLDG FIRE SPRINNLERS PEO'D BFSEMENT MECHANICAL <br /> i- YES = NO <br /> OGCUPANCV LOAO FlRE AIAPM REOD HEIGHT LIMIIATION ADDITIONAI PLAN CHECK _ <br /> OTHER � <br /> REn50N � <br /> STATE BUILDING SURCHARGE i <br /> I'JTANEO'! PLANSPPPROVEDBY CITYOFFVERETT PUBLICWORK$ <br /> LOCALSALES <br /> onre TAX COUE IS 3105 TOTAL <br />