Laserfiche WebLink
i <br /> APPLICATI"�N FOR CONSTRUC� .ON PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT ' � HEAT�EM: ❑GAS �ELECTRIC ❑ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION X� BUILDING :7MECHANICAL 1= PLUMBING ❑ SIGN <br /> OWNER IdAILA�DRESS Cli� ZIP PHONE <br /> Burlington N RR. 176 E. 5th St. St. Paul MN 55101 612-29$-3300 <br /> TENNNT IdAILAODRESS Cilv ZIP PHONE <br /> ARCHITECTORbc�!�NER MAILADDRESS CnY ZIP PHONE <br /> N:iles Chris :.ensen 176 E. 5th St. St. Paul, NN 55101 612-29�-3300 , <br /> GENEF4LCONTRACTOR MAILAD�RESS COY ZIP PHON[ SiATEUCENSEa <br /> (�;r7n.eh� <br /> MECMFNICALCONTRACTOR MAILADDRE55 Glil' ZIP PHO'JE STATEUCENSEa �� � <br /> PIUMBINGCONTRFCTOfl MFILAD�RE55 Cilti ZIP PNONE STATELI�ENSE> <br /> CONiRACTPRICEOFWOflK �^IQOM1 . <br /> � �J <br /> �ESCRIBEWOfiNANDSOUAREFOOTAGEINVOLVED CONiAGiPERSON PMON���' ` �'2� <br /> Install �refahriczted 160 s ft eaui me t Y��, <br /> shelter and erect 14�0 ft sel.f sunportin � (�7 - j�:�9 _i <br /> tower fOY' T3a] 0 repeater station i HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AIJ�KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Te].ecommunications equipment shelter PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> LEGALLESCRIPTIONOFPFOPERTV�SHOWNBELOWORARACHNlOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE-IN OF�. <br /> NOT. THE GRANTWG OF A PEFlMIT DOES NOT PRESUME TO GI\'E. <br /> LOT-- BLOCK oF qUTHORITY TO VIOLA'E OR C�NCEL THE PROVISIONS QF AN1 <br /> pTHER STATE OR LOCHL LAW REGULATING CONSTRUCTION UR THi <br /> -- - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY 1!ii <br /> OWNER OF THIS PROPERTY TO PERPORM THE WORK FOR WHICi� <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATL <br /> PAPCEL TA%I.D.NU1dBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOhNLEN�ER,AODRESS.TELEPHONE NUMBER ,/ <br /> � PFiOJECT ADDR 'SS �- � - - _�L�" <br /> sic�uau�e —o+*c <br /> -� o� �J � urvouvr+essuceusem �- — <br /> PLUMBIhu MECHANICAL <br /> N0. TYPE OF FI7(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FE� <br /> � WATER CLOSET(TOILET) � A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—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 I <br /> DISHWASHER RANGE HOOG �— <br /> L;UNDRY TfiAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FISEPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> — �-- <br /> BACKPLOW PREVENTERS ' GAS PIPING <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) arr;A,- e�_pnyt_Gleathesma _. <br /> 0,200 BTU Cooling ____�_ <br /> ,200 BTU Heatin <br /> � <br /> SUB TOTAL 5 ' SUB TOTAL S �� <br /> PERMIT S PERMIT 5 <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FFONTSETD�CK REARSETBACN SIDESETBACN PLANCM[CKNU�dBER FE[ FELEIPTNO <br /> ����a <br /> usezoNe iornnen vncnntsire FEES VALUATION FEE <br /> �-� ;J YES r'1 NO BWLDING �•� (yfQ � ? nr' ;JU <br /> iVCEOFCONSi. NO.OFSTORIES a[u�avtr NoarCw.f:r.aulu5 --- �� - <br /> .Tr� � / caouv � pLUMBING ' <br /> .Y/V �� <br /> SIZEOFBL�G. FIRESPflINKLERSREO'� �ASEIdENT <br /> IGC�5� '�}"' �� �; YES X P70 MECHANICAL �� � � <br /> �, �� ADOITIONAL PLAN CHECK <br /> OCCUPANCYLOAD FIRLAL�RIdpEO'D HEIGHTLIIAiT4TIUq �,S�Ji ��� <br /> 2 Nv � --- --- -- <br /> _ �� _ _ OTMER <br /> REa50f. "____. _� <br /> ST.ATE RUILDING SURCHAFGE � <br /> INTAK[13Y PL�NSAPPROVEDBY CITYOFEVERETT PUBLICflORKS 1— <br /> � LOCAL SAL'eS <br /> onre �/3�yq TAX CODE IS 3105 707AL ��� �`� J� <br /> — r� — <br />