Laserfiche WebLink
APPLICATIO!" FOR CONSTRUCTI^N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEATING SYSTEM� � GAS 'J ELECTRIC `J —� <br />BUILDING DEPARTMENT <br />259-8810 <br />iJ DEMOLITION � I COMBINATION BUILDING Jt MECHANICAL I; PLUMBING I I SIGN <br />OYlNEfl M1INL�pDRESS CITY ZIP PMONE <br />FiOiGd�'rr i�iecf �Gr.�vAt� Ci.u.E3 ,(,S'ee �,Z'^0 s.- E,vEk+err, (,�_ 9��Qi� <br />TENANT MqILA0DFE5S CITY 21P PHONE <br />ARGHITECTOROESIGNER MAILq0�FE55 CIT ZIP PHONE <br />, /1iYl9YSel�rscFsl.,� ISF9e9N� �ss' ���..,..,n U10 9�rRsz. MMiSEL�o9�{P! <br />MAR <br />�ECHFNICALCONTR�CTOF MAILADDRESS <br />PLUMBINGCONiRACTOH MAILAD�RE55 <br />CONTR�CT PRICE F WOHN <br />�il e�n eo <br />DUILDING <br />LEGAL DESCFIPTIOI! OF PROPERTV �SMOWN BEiOW OR ATTALH TWO GOPIES) <br />LOT BLOGK OF <br />PAPCEL TA%1 p. Nl11dBER <br />GONSiRUCTION LOAN LENOER. ADDRF.SS. TELEPHONE NI1b:9ER <br />PLUMBING <br />0. TYPE OF FIXTURE OR ITEM <br />WATEFl CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KIiCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRA��' <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRGNT SETBACH REAR SETBACK <br />USE ZONE <br />TYPE OF WNSi. <br />SIZE OF BLDG. <br />OCCUPANCVL <br />REASON <br />INTAI(E BV <br />LOT AREA <br />PERMIT 5 <br />TOTAL FEE S <br />SIDE SEIBACK <br />FIRE SPFINKLERS REOD <br />FIFE ALARAI REO�D <br />PLANS �PPROVED DY <br />.!M <br />DFiE I/l/lA�s <br />CITY ZIP <br />(� <br />CITY ZIP <br />FEE <br />CONTACT <br />?NONE S7ATE LICENS[ k <br />PHG�� STATE L�� <br />PMONE STATF IICENSE a <br />i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESLIME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />� <br />•.icrvnruee nni <br />LrtVBU5WES5liL[ .� i0 � <br />MECHANICAL <br />NO. TYPE OF F.QUIPMENT FEE <br />AIC—AIHNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD �— <br />WATER HEATER ' <br />WOOD �TOVE � <br />METAL FlREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT ; <br />T <br />HEAT PUMP � <br />GAS PIPING ' <br />'J EXHAUST FAN � <br />PL�NCHECKNUMBER � fEE <br />VACANT SI7E FEES <br />'�.� YES �'; NO BUILDING <br />occuvar:cv �:oavowewr��w���s — <br />caouv — p�UM81NG _ <br />BnSEMENr MECHANICAL <br />I �. YES . ' NO — <br />NEiGiiT uMimnoru /+�DITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFiCHAFGE <br />CITY Of EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTALFEE 5 , <br />