Laserfiche WebLink
APPLICATION FOR COPiSTRUCT��i PERIVI���' � <br />TO E3E C�dIPLETED IN BLACK INK—PLEASE PFitv � <br />HEATIN U GAS IJ ELECTRIC C� <br />BUILDING DEPARTMENT '--- <br />259-8810 <br />I! DEMOLITION I I COMBINATION <br />OWNER IdAIL.100flE55 <br />�W"_��uck �sl�o �-UKM,': <br />MAIL A�DRESS <br />pHCHITGGT OR DESIGYER <br />r, �, I-��h��. <br />I[GHN IC�L CONiP�CiOR <br />�, u ; <br />'Wfd�ING CONTBACTGB <br />1 ' i -i <br />.�=".,', "_ -.��— <br />CONTR�CT PRIGE OF WONN <br />oescaioe <br />I.IAII �D�RESS <br />1,IAIL AODFESSy <br />�_ jia�f' 0 ,\ /i;i� LC ��G <br />rnna noor+ess <br />; �, ra�-� ��. �� <br />rnni� nooness /y.( <br />I . � Sy' (iw <br />, ,::-/... G,7 - — <br />IE ppTp�E �NyO�VED <br />.�o�,��it <br />�- 7 � <br />I✓BUILDING <br />c�— <br />iG� �rtaF'. <br />CITV <br />GO Y <br />!`(MECHA�ICAL <br />�-����.� <br />33���K��l <br />PHONE <br />PHONE <br />1 �fRlS[ tl <br />I I SIGN <br />� �,� �i� ; ��a�oa�� RA ��,,as o�s Nr � <br />✓Iloil L/r% -/.�-i�" _. <br />Z�P PIIONE Sl IE LICENSE u <br />crtr „10�+_,0 <br />, r+; <br />�. �-., w�+ 98a3 � 7 s''� �%� �i 2!' � R:�: <br />CITY 7�P PMONE STATE uCEHSE o <br />,..��..�..,.,� ��a9a G>'a��i�� `��u�,-, �p 1�.�M <br />CON7ACT PERSJN AND PMONE NO. <br />7,,�ia� S�h <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED e oF eui�oir�c � � � i., pROVISIONS Of� LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />��_i i,p �a..��:..��o� ��C.L�o _ <br />�-•�..-. WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�ccnioe��Ccjairn +o�rROFEaTvis�ov� ee�owoanrrncHrw coriesi NOT. THC- GRANTWG OF A PERMIT DOES NOT PRESUME TO GNE <br />ior-�+-- o�ocK aF �' � �� �� AUTHORITY TO VIOLATE Ofl CANCt L THE PROVISIONS OF AN\ <br />OTHER STATE OR !.00AL LAW HCGULATING CONSTRUCTION OR THP <br />�,���i� __ — PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIIORI2ED BY THL <br />� OWNER OP THIS FROPERTY TO PEFFORM THE WORK FOF W411Ci <br />APPLICATION IS �dADE AND I COMPLY VlITH THE STAL. <br />r�n�ce� Tnn i u rvuMee� CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />GONSTRUCTION LOAN LENDLR. ADDRESS. TEIEPHONE NUMBER �X .���1 .� ���, — 7 S/_ <br />DAIC <br />1 SIGYAIIIPC � <br />PROJECTADDRESS ��' ���l�f cnruus�ncssuccns���o — <br />ll/�a �� Co ----• — <br />pi. <br />N0. <br />� <br />V TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WA:;H BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TflAY <br />CLOTHES WhSHER <br />URINAL �_ <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.) <br />FOR OF�ICE USE ONLY: <br />FRONTSETBACH RFARSL7�AGK <br />i / <br />2U ��o <br />��— O ARbA <br />�s� ro�� ' � 9 6 <br />iYPE OF COflSi. NO Of STORIE <br />u <br />RE�SON <br />IN•ANE 0� <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 5 <br />� FIRESPBINKLERSRW'D <br />F� T <br />G� <br />iono rwe n�neM aeo�o <br />p�nr+s nrr ov�o ov <br />onrE � � � 5 S <br />0 <br />0 <br />0 <br />TYPE OF E�UIPMENT FEE <br />NC—A/HNDLG UNITS—H.P. _ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES�RYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATeR HEATER <br />WOOD STOVE <br />METAL FIREPLACE (1NOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING __ <br />EXHAUSTFAN <br />�__ __.,.nb2..r . � <br />SI�ESE70PCN PLANGHECKNU1d0ER <br />� y � c o,� <br />vncnm srte FEES <br />i: YES i:�� NO gUi�DiNG <br />UC[bPAHCv 110 OIPNCILINGOdIU <br />cuac3 � PLUM�ING _ <br />�� <br />BASEMENT � MECHANICAL <br />� i YES iN" NO <br />HEIGHi L�L��TATIONu �DDRIONAL PLAN CHGCK <br />'Z�(J OiHER <br />STATE BUILDING SURCHAFGE <br />CITY DF EVERETT PUOLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3?C5 Torn� _ <br />�i� <br />_ � <br />SUBTOTAL 5 —+ <br />PERMIT S ' <br />TOTAL FEE S � <br />', D <br />� <br />0 <br />