Laserfiche WebLink
APPLICATIC l FOR CONSTRUCT�)N PERM14 � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS � ELECTRIC fJ <br />259-8610 <br />❑ DEMOLITION ❑ COMBINATION C i BUILDING '�MECHANICAL CI PLUMBING ❑ SIGN <br />T�R � AfAILA�DFE55 /'?� CIiY ZIP PMONE /� <br />C,� �1V� ^ 1�"lAFIL�AD�RE55,��^I� �'iJOC/. J�\��� 1\P� �.I/C l l HONE �1I W� /I �(nJ <br />AFCHITECTOROESIGNER MAILADDRE55 CITV ZIP PMONE <br />GENERAL GONTRACTOR MNL ADDRESS CITV ZIP PHONE S7ATE LICENSE k <br />MECHqNI1C1RLICON�FACiOR MFILFDDRESS CITY IIP PHONE ST4TEUCENSEN <br />�w� <br />PLUMBING CONTRAC'OR MAIL ADDRESS CITV ZIP PHONE STFTE UCENSE a <br />CONTRACT PRILE OF WOP.K <br />���1 � <br />�ESCRIBE WORK AN� SOUA E FOOTAGE INVOLVED CONTACT PERSON AND FHONE NO. <br />LEGAI DESCFIPTION OF PROPERTY �SNOWN BELOW OR ATTFCH TWO COPIES� <br />LOT BLOCK OF <br />PARCELTAXI.O.NUMBER <br />GONSTRUCTIONLOANLENOER,AODRE5$ �TELEPHONENUMBER <br />!'.,!'i/'^� �'1 CL i ✓\ .-� , i .o <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEAC <br />SINK (SERVICE-BAR. ETC <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSET�ACK <br />USEZONE LOTAREA <br />1VPEOfCONSi. NO.OFSTORIES <br />SREO- BL�G. FIRESPRINNLERSRCO'0 <br />OCCUPANCY LOAO FIPE ALAFlA REO'D <br />REASON <br />INTAKEBV PLANSAPPROVE�BY <br />DATE <br />FEE <br />-� <br />� <br />� <br />N <br />R <br />0 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINAPICES GOVERNING THIS TYPE OF <br />WURK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING UF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW F;EGULATING CONSTRUCTION OR THE <br />PERFORMANCF OF CONSTRUCTION. THAT I AM AU'lHORiZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP CAiIION IS MA E AND I COMPLY WITH THE STATE <br />C TRACV�RS LAW 1 27 �N AND 296.200 WAC. <br />N0. TYPE OF EOUIPMENT � <br />A/(r 'HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RA�1GE HOOD <br />WATEfl HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />� GAS PIPING <br />�JC EXHAUST FAN <br />SIDESETBFCK PLANCHECKNlIh1BER PEE <br />VACANiSITL fEES I <br />r� YES ❑ NO BUILDING <br />OLCOPAIILY I:OAfDKELLIM160Ni15 � <br />caoce pLUMBING ' <br />BnSEi!ENT MECHANICAL <br />❑ YES ❑ NO <br />HE:CHTLIMIiAiION AODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFiCHARGE � <br />f,ITY OF EVERETT pUBLIC WORKS <br />�ocn� sa�es <br />TAX CODFIS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE 5 <br />� <br />FEE <br />0 <br />0 <br />N <br />�p <br />n <br />� <br />� <br />� <br />