Laserfiche WebLink
APPLICATIf Y FOR CONSTRUCT 7N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELEC7RIC �_�(/�i� <br />259•8810 <br />C� DEMOLITION f 1 COMBINATION IX BUILDIY :•: ! i MECHANICAL �: PLUMBING C i SIGN <br />OWNEP�-. MAILA�DRE55 C�TY Z PHON[ / <br />i / L� <br />�7C.�Ai 7hIC(fF�1-�DS �7�1�� 1l.-�,U�ll/V�,%O�L� C����/'-��'i ��"t'�� ?Sh - ���'S <br />i[NRNT �dqRqOG�E55 T <br />nRCNITECI OR DF.SIGNER <br />GENERALCONTPACTOR <br />PLUMBtNG <br />MAIL ADORESS <br />MqIL pDDRESS <br />MI.IL ADORE55 <br />MAIL AODRESS <br />CONiRAGT PRICE OF WORK <br />29� - <br />DESCRIBE WONK RND SOIIRRE FOOTA4E INVOLV[D <br />G V ZIP <br />CITV 2. <br />CITY ZIP <br />ZIP <br />ZIP <br />N0 <br />PNONE <br />PNONE <br />PNONE <br />PHONE <br />PMONE <br />SiATE LI�ENSE � <br />STATE LICENSE � <br />STFT[ UCENSE • <br />�-� � -/�l <br />i HEREBY CERTIFY THAT I HAVE RE�D AND E%AMINED THIS <br />PROPOSEOUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREJT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />iecn�oescaianeNOFVRoaearvisNowneeiowoanrmcr�rwocoaies WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />ioT '��= a�ceK � oFCGAlTA�i-�— f�'��I� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />/ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�Y D � •r� �= U tT�� �� OTHER STATE OR LOCAL LAW R2GULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />P�RCEITA%IO.NUMCER <br />Q?� _� � �_ ���- ��-/T�f(J CONTRACTORS LAW 182 D 296200 WAC. <br />�� ^/ n 7 <br />CONSTRUGiIONLORNLENDER.ADORESS,TEIEPHONENUMBER ` V / r A �/ �� <br />� /LJ� CJZ-lii� c%.Q,�a <br />TYPE OF fl7(TURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWA$HER <br />BACKFLOW PREVENTERS <br />ROOF GRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.1 <br />PERMIT <br />FOR OFFICE USE ONLY: <br />FRONTSGTBACK REFflS[ipACK <br />USEZONE LpTqREA <br />3 Z �.�J CD�j 1_ <br />TVPEOfCONSi. NO.OFSTOR�ES <br />Y -� � <br />SRE OF L,3. FIRE SPRINM.LERS RE00 <br />� (o $.F. .� � <br />OCGUPANLY LOAO FIRE ALARM REO'D <br />REASON <br />INTANE BV PLANS APPqO�VyEO BY <br />on1E %C/Jc/ <br />0 <br />$ <br />$ <br />$ <br />wessuc.[xst xo <br />IANICAL <br />TYPE OF EOUIPN <br />NC—ArHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS-8. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />IdETAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />ExHAUSTFAN <br />F�DF.SETBRCK PLFNCHECKNUM1IpEP FEE <br />�D� F►ovr C�v�i�U J <br />VACFNT Sli[ FEES <br />. �. YES � 1 NO dUiLOiNG <br />lkCu A'iCV N] 04 [ry4F1lIVG �IHiIF <br />"°"° r�u+neirvc <br />-I <br />9ASEMENT � � MECHANICAL <br />�-i YES .VNO <br />F�EIGHi liMltaTiDN ADDITIONAI PLAN CHECK <br />�' ( OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUOLIC WORHS <br />LOCR!.SALES <br />TAX CODE IS 3105 TOTAL <br />SUB T(1TAL 5 <br />PERMIT. 5 <br />TOTALFEF 5 <br />NO <br />i <br />� <br />