Laserfiche WebLink
APPLICATIa_ J FOR CONSTRUCTl, JN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: )Q GAS J ELECTRIC J <br />259.8810 <br />DEMOLITION COMBINATION BUILDING )(MECHANICAL PLUMBING SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />t"uum►lr',#utcK /Ip3 -73 >r o. Fooffi " 36r—f?If <br />ANT DRESS / ^ � ,I�CITY � �jlPHONE <br />AFICHITECTIIJA DESIGNER MAR ADDRESS f/ N CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />ILIAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IT <br />�mg <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CLASS OF WORK <br />I 1 NEW ADDITION It ALTERATION REPAIR DEMOLITION I 1 WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />CONTACA T PERSO ND PHOLLNE NO <br />�I <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED E <br />9L94: f MtD 7aGAS. ft"A** 6ASkJ4r7D 6 <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION Or PROPERTY ISHOWNBEIOW OR ATTACH FOUR COPIESI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOr _ BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />— <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />PROJECT ADDRESS <br />504ATURE D.TE <br />/03 S • <br />DIiv PVSM49l KENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOIL ET) <br />AC-A/HNDLG UNITS-H.P. <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS-B.TU. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLO"HES DRYERS <br />' <br />KITCHEN SINK & DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />--� <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />_; <br />WATER HCATEH <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />; <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />I <br />I <br />I <br />I <br />_ <br />I <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />O ' <br />PERMIT $ <br />PERMIT $ <br />— <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK T REARSETRACI. SIDE SETBACK <br />RECEIPT NO <br />USE ZONE <br />LOT AREA <br />VACANT SIZE <br />•cca <br />-- <br />BUILDING <br />PLUMBING <br />-- <br />TYPE OF CONES ALLOWABLE <br />TYPE Of CONST ACTUAL <br />(ICLIIPAAEY <br />SAaIJr <br />NO apMllPIG UNHe <br />I <br />i <br />MECHANICAL <br />I <br />' <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD FIRE SPRINKLERS REG D HEIGHT LIMITATION <br />I <br />SPRINKLER <br />i <br />REASON FDA SPRINKLERS <br />STATE BUILDING SURCHARGE <br />� <br />Y OFEVERETT <br />INTAKE BY PLANS APPRUVEDflYTcl" <br />PUBLIC WORKSLOCAL <br />SALES <br />7TAX <br />CODE IS 3105 <br />TOTAL <br />; <br />11 <br />