Laserfiche WebLink
APPLICATIQ'1 FOR CONSTRUCT'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS i�ELECTRIC ❑ l <br /> 259-8610 <br /> � ; DEMOLITION i i COMBINATION ! ' BUILDING ❑MECHANICAL ❑PLUMBING SIGN <br /> OWNER � IAAILAODRESS CITV � ZIP PHO E <br /> �u/c� //�esc'iz LaG'r5=�>4J�v�sT G�r%�4� /�/.�37 �v�-/� SE ,'7?� e� Gtcr�/c_ _ <br /> TENANT MAILADDRE55 CITY ZIP PHONE ��O'� <br /> / <br /> ��� <br /> RRCHITECTORDESIGNER MAILADDRESS GTY ZIP PMONE <br /> !V L <br /> GENERRL CONTRACTOR MAIL AUDRCSS QTV � IIP PHONE STRTE UCENSE� <br /> ��,i»G�i_��/C�J4ii' Scw�v«,- lJar'?�yS /_'"v:P'�k 9�� ��3 3�1 si�ls �f)/11/1E.773d'�9� <br /> MECHANICRLC^O/NTRACTOR UAILpDDRE55 CITV ZIP PHONE STATEUCENSE� <br /> �/ ✓ <br /> PLUMBING LONTRACTOR MAIL AODRE55 CITV ZIP PNONE iTATE LICENS[• <br /> /1�J <br /> CONTRACT PRICE OF WORK <br /> `�i ?O O, , . n� <br /> DESC E WORK ANO SOUARE FOO GE INVOLV�p CON7AGT PERSON AND PMONE N0. <br /> YN � /.J- v: 7 /!'G5"J�' — <br /> 7 �P v ,�'cc /� c.� �� /.s�.. s <br /> ���t`� �`� ��' `��' I HEREBY CERTIFV THAT I HAVE READ AND EXAIdINED THIS <br /> anovoseo use oF euaoiNc APPLICATION AND KNOW THE SFME TO BE TFUE AND CORRECT. ALL <br /> �C/ � �E � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGAIDE RIPTIONOFPPOP[RTV�SHOWNBELOWOA4TTPCHTN'OLOPIES) WORK WILL BE COMPLETED WI7H WHETHER SPECIFIEG HEREIN OR <br /> NOT. THE GRANTING OF A F'ERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVIS�ONS OF ANV <br /> OTHER S?ATE OR LOCAL lAW REGULATING CONSTRUCTION OR TH[ <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Pnace�tn i.o rvu ER ��y� CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �' (�'., - �5.5�- U�O�� <br /> CONSTRUGTIONLORNLENDER,PDDRESS.TELEPHONE NUMBEfl �' �/ <br /> x.����:�w-1` �-zs=9,— <br /> PROJECTADDRESS/-O�� �! �(,NS� s�cr��iune o�*� _ <br /> (fJ �](/G�./� ci*veaswcssuc[eser.o <br /> PLUMBING MECHIINICAL <br /> N0. TYPE OF FIRTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—AiHNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> —�— <br /> SHOWER CLOTHESDRVERS _, <br /> KITCHEN SINK 8 DISP VENTILATION FAN i _ <br /> DISHWASHER � RANGEHOOD . <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP __ <br /> BACKFLOW PREVENTERS ; GAS PIPING I _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) - <br /> SUBTOTAL $ SUBTOTAL 5 _ <br /> PERMIT 5 PERMIT S __ <br /> TOTAI FEE 5 TOTAL FEE $ �— <br /> FOR OFFICE USE ONLY: <br /> iRONT5ET84CR HEARSETBACN SIDE SEiBAGK PLnNCHE KNUMBER FEE RECEIPTNO. <br /> ����5 <br /> usezor+e iotnnen vncnNisite FEES VALUATION FEE <br /> ._' YES , � NO gUILDING 2G <br /> TYPEOiCON51. NO.OFSTORIES ottw�xcr Nnp�mvFi�.ixsuv�tt — <br /> taouv pUJMBING <br /> --+— <br /> SRE OF BLDG. FIRE SPRiNKLERS REO'D BAS[MENT MECHANICAL <br /> '--. YES � NO — � -- <br /> OCCUPANCYLORD FIREALARMREOD HEIGNTIIMIiAT10N <br /> ADDITIONAL PLAN CHECK � <br /> OTHER <br /> flEF50N � / � <br /> STATE BUILDING SURCHARGE <br /> INTFKE BY PLANS RPPROVEDBY CITY OF EVERETT PU�LIC WORFS <br /> LOCAL SALES � / <br /> oA,E TAX CODE IS 3105 TOTAL �'�' Z� <br />