Laserfiche WebLink
APPLICATIC 1 FOR CONSTRUCT��1� PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: !J GAS O ELECTRIC U <br /> BUILDING DEPARI'MENT <br /> 259-8810 <br /> L 1 DEMOLITION !J COMBINATION i i BUILDING j(I MECHANICAL i 1 PLUMBING I SIGN <br /> OWNER MIIILAODRESS GTY 21P PNONE <br /> //1/l1E G"r�YrrX l Z� Vic_:J � �Gc aK . E'V; 98zo3 �,s ,Z75 <br /> TLNANT MARqD�RE55 CRV ZIP P�IONE <br /> pRCHITECiORDE5IGNER MAILAODRE55 CITY ZIP PMONE <br /> GENERALLONTP/CTOR MAILAD�RESS GTV 21P PHONE STATEUCENSEt <br /> MECHRNICALCONiRFGTOR MAIL ADD9E55 CITY ZIP PHONE STATE UCENSE/ <br /> �i/ic I f�•c�Y.1li s-��.%Z !'// t ,� r- �`8 cT/%- ig7<� 353-33/v .�IrJii/o�qa� _ <br /> PWMBINGCONTRACTOR MAILFDDRE55 Cltt 71P PNONE STA1ELiCENSE� <br /> CONTRAGT PRICE OF WO�fl/N <br /> (J.�' [J <br /> OESCRIPE WORK�ND SOU4RE FOOtAG[INV0.VG0 CONTAGT PERSON AND PHONC N0. <br /> I HERcB�' CERTIFY THAT I HAVE RE�D AND EXAMINED THIS <br /> PROPOSEUUSEOf BWLDiNG APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRGCT.ALL <br /> �F'�a PROVISIONS OF LAWS ANG ORDINANCES GOVERNING TNIS NPF OF <br /> LEGRLOESCRIPTIONOFPROPERtt�5M014N0ElOWORATfAC11TWOCOPIE51 WOFK WILL BE COMPLETEII WI7H WHET4ER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVL <br /> ior e�ocK oF AUTHORITV TO VIOLATE OR CAWCEL THE PROVISICNS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIIJG CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THF WORK FOR WHICF: <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnace�tnz i o.r+uMeee CONT CTORS LAW 1827 FlCW AND 296200 WAC. <br /> . p' �o� <br /> CONSiRUGTIONIOPNLENDER.AppRESS.T[LEPNONENUMBER <br /> ��)'3 <br /> PROJECT ADDRESS s� v`.''���. oAi� <br /> 3� �������� �Q_ lVf+l6ME55l1CFV5FN0 <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AiHNDLG UNITS—H.P. � <br /> BATHTUB f FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP I VENTII.ATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY / WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UAINAL METAL FIREPLACE(WOOD BURNIVG) <br /> DRINKING FOUNTAIN FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP : <br /> BACKFLOW PREVENTERS ; ')i GAS PIPING _�_ <br /> ROOF DRAINS—RAINLEAuERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> i <br /> i <br /> —� <br /> SUBTOTAL 5 SUBTOTAL $ O ' � <br /> PERMIT S PERMIT S / � <br /> TOTALFEE 5 TOTALfEE 5 ��� <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN HEARSET�ACH SICESETBALN 'LPNLHECHNUM66R �E[ RECE�PTNJ <br /> ���� �L <br /> use zoNe �or nAen VACANT SITE FEES VALUATION FEE �_ <br /> �� YES , ! NO yU�LDiNG <br /> ivPE Oi CON57. MOAF STORIES acu��xn �:�a PSEwxcuens � — � <br /> �P00P PLUMBING <br /> SiZEOFBLDG. FlRESPPINKlERSREOD BRSE6IENT MECNANICAL <br /> ,-� YES "� NO <br /> OCCUPANCY IORD FIFE AURM REOD NEIGHi LIMITATtON ADDITIONAL PLAN CMECK <br /> OTHEF <br /> PEASON � <br /> STATE BUILDING SURCNARGE <br /> MTAKE BY PLANSAPPFOVE�BV CITY OF EVERETT PUBLIC WORKS <br /> �ocn�sa�es <br /> oATE TAX CODE IS 3105 rorn� <br />