Laserfiche WebLink
APPLICATIC ] FOR CONSTRUCT. )N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS 'J ELECTRIC :J � <br /> 259-8810 <br /> DEMOLITION i COMBINATION BUILDINa^ /MECHANICAL �LUMBING ] SIGN <br /> ���^ ' ��IAAIL A�ESS CIiY ZIP PHONE <br /> i ANT' �, �A,ooAESl�t�i� �r c—��� ���� ���q ���- <br /> CITY ZIP PM01lE <br /> 3 E�UG�� �-T �a�e�r� ��f(��,! �3`► �3Q� <br /> � HITECT OR pESIGNER MAIL/+DDRESS CITV LIP PHONE <br /> GE EflALGONTqACTOR h1AI�A0DPE55 ZIP PMONE ST�TELI NSEa <br /> L\�� I I�(ki�21��;�-i� a-Kno '��n c0(� k-� SF ll�l—��- `����-2 0 i af-�1a3� <br /> ��EZ'�HANICA�CONTRACTOF �AAILADDRESS C17V 21P PHONE <br /> �� ^ „� STAiE�ICENSEp <br /> �V1 <br /> PWIIBINGCONTRACTOR f�ILA00RE55 CITV 21P Ph!ONE STATELICENSEu <br /> �'{�m� <br /> GONTR ..TPqIGEOFWORK � — <br /> .�� <br /> DESC IEE WORR AND SOUARE FOOTAGE NVOLVED CONTACT PERSON AND PHONE NO. <br /> - 3 - <br /> �L"�� �w� I HEREBV CER7IFY THAT I HAVE READ A��D EXAMINED THIS <br /> PR�O OSED USE OF �oiN� APPLICATION AND KNOW THE SAME TO BE TRUE \NU CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEf i;NG THIS TYPE OF <br /> LEGFLDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTI'fOCOP1E5) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCN aF NOT. THE GRANTING OF A PERMIT DOES NOT PRE;'.UME TO GIVE <br /> AUTHORITY' TO VIOLATE OR CANCEL THE P50VISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTiON OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY T ERFORM THE WORK FOR WHICH <br /> PFqCELTA%I.D.NUMBER I ' // APPLICATI I COMPLY WITH THE STATE <br /> O l O � —U`t CONT ORS LA6 ^ C AND 296.200 WAC. <br /> CONSTRUCTIONL N ENOER.AODRESSTE�EPHONENUIdBEF / � � <br /> PROJECT ADDRESS sic��n.une pq � <br /> �� � � cirveusriessuc,erntuo <br /> � PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> , BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS , <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN <br /> DISHWASHER _ RANGE HOOD , <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(bV00D BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � � � <br /> H .AT PUMP , <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � � <br /> SUB TOTAL 5 ' I <br /> � SUB TOTAL S <br /> PERMIT $ PERMIT S I <br /> TOTAL FEE 5 ' TOTAL FEE § <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBACK REAqSET3�CK SIOESETBACK PLANCHECKN MBER fEE RECEIPTNO. <br /> 3� <br /> usEzoNe �ornaEn VACANTSITE FEES VALUATION FEE <br /> ��,f: YES i-: NO BUILDING <br /> i'!PE OF CONSt NO.OP STORIES occcaaxcr n0 orowRuc6��ms <br /> I GPpUP <br /> PLU1dBING <br /> SREOFBL�G. FIRESPRINKLERSREOD BAS[MFNT 1dECHANICAL <br /> . YES �.-i NO <br /> OCCUPANCY LOFD FlpE�IFPM REOD HEIGMT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER ' <br /> aEASON <br /> i— <br /> STATE BUILDING SURCHARGE <br /> MTFNEGV PL�NSAPPROVED�V CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES <br /> onre TAX CODE IS 3105 TOTAL <br />