Laserfiche WebLink
APPLICATIQ�?I FOR CONSTRUCT��D1�1 PERMI7 �✓�� <br /> TO BE C�iNPLETED IN BLACK INK–PLEASE PRIN f <br /> BU�LDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ --1 <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING C SIGN <br /> OWrNEFl MA'IADDRESS GITV ZIP PHO(N/E � <br /> /'EC.TW �CP��I�AIL PODRE55 ' � Nw l CITY 21�I� PN" UI� <br /> AFCHITECTORDESIGNER MAILADDRESS 5 V�'� CITY 21P PPONE <br /> s Ku�r�Y AS�� i2ssU ��,�;�i�� � .s�,�rr� ��igg S��— H/�o <br /> GENERAL CONTRACTOR MAIL�D�RE55 � CITY ZIP PHONE TATE L'CENSE u <br /> M ETC��tl�5 T��.�.� ' <br /> MECHANICAICONTRACTO IAAILADORE55 CITY 21P PHONE STATELICENSEF <br /> PLUMBING CON'RACTOfl MAIL nDDRESS CITY ZIP PIIJNc STATE UCENSE tl <br /> CONTflACT PRICE OF WOFK ` � <br /> 1 <br /> -"�-- <br /> DESCRIBE OflK AND$OUAR�P GE INVOLy �]� � c � CO4TFCT PEFlSON AN�PHONE NO. /��� � <br /> 7n I 5 t�� - . -JI�u l�-�iU:wt"v - �ilth�- — �j�����(a t'� � � S <br /> J. �?g Ltv; Q � <br /> � � ��Z �L� Ii�l+�'�-� e"��I `'��"'�_ i HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �esPosj��or-v oiNc--- APPLICATION AND KNO'N THE SAME TO OE TRUE AND CORRECT.ALL <br /> � [� / –. j PROVISIONS OF LAWS AND ORDINANCES GOVERNItJG THIS TYPE OF <br /> . �E�SCRIPTION PPOPERTY�:�"OWNBELOWORATTACHTWOGOPIES� WOflK WILL BF COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiarc-- oF F.UTHORITI' TO VIOLATE OR CANCf_L THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — -- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED�Y THE <br /> OWNER 0� THIS PR�PERTY TO PEqFORM THE WORK FOR WHICH <br /> - --- -� APPLICATIO� IS MADE AND I COMPLY WITH THE STATE <br /> PPRCEL TA%LU.NUMBER CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> CONSTRIICT10NlOANLENDER.AODRESS.?ELLPH9HENUMBEF ��� J � �� � / � <br /> I ��' Z.7 �9 y <br /> . PROJECT ADDRE �� ,/ � n �� �✓s��r+nrune oeiE <br /> --� 1 —. <br /> � r (,�� � CIT�BUSiNE55LI:EN5EN0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEG NO. TYPE OF E�UIPMENT FEE <br /> WATEH CLOSET(TOILET) � A/C—A/HNDIG UNITS—H.P. <br /> � � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATOFY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> �^ SHOWER ' CLOTHES DR'lFFS ! <br /> KITCHEN SINK 8 DISP ; VENTILATIOPI Fl N ; <br /> ! DISHWASHER RANGEHOO� <br /> LAUNDflYTRAY ; WATER HEATER <br /> CLOTHES WASHEA WOODSTOVE <br /> URWAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRP.IN � HEAT PUMP � <br /> BACKFLC'N PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.� ; ; _ <br /> � <br /> � � _ <br /> � � <br /> � <br /> � � <br /> � <br /> SU5 TOTAL $ ; SUB TOTAL $ <br /> PERMIT S � PERMIT $ <br /> TOTAL FEE S ; TOTAL FEE S ' I <br /> FOR OFFICE USE ONLY: I <br /> FRONTSEiBACK REARSETBACH SI�ESEi�ACK PLaNC�ME`�UU��� FEE���� /�� RECEIPTIIO`��� I <br /> U �i <br /> useZC�Ne LOTAtiFA vncnNrsrte FEES VALUATION FEE �� <br /> n vEs n No -� <br /> BlI1LDING ` !�9/ 7n <br /> � <br /> IV�'LUICO�l51. �:O.Of-SiORIGS occuiw.cr nunruv�Ruucusns — � � �,) —' <br /> YYl 1 2 �c� °P /J PLUMBING _ //�y; <br /> .7LlV .r' —_1_r.r_ct.�_ <br /> SREOF�LDG. FIHESPRINNLERSREO'� B SE!dENT MECHANICAL <br /> ��`1713 ND ❑ ves >C No �; <br /> OCGUPnrGYLOnG F�R[nInPMFEo'D HEIGHT�RdITniION ADUITIqNALPLADICHECK i <br /> ��� - —�— <br /> i <br /> I�✓ OTIIER ' — <br /> �i i <br /> qEA50t! --- 'T <br /> �1��,��,� STAiE BUILOING SURCHARGE ____��;,z� <br /> Itl1�KF.�V ALANSAPPROVEDOY � <br /> CITY OF EVERETT PUBLIC WORKS <br /> �M LOCALSALES �— <br /> _ on,� rL � TAX CODE IS 3105 TOIAL � <br /> "Z*,. <br />