Laserfiche WebLink
APPLICATIC-1 FOR CONSTRUCTAiN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />L I DEMOLITION 1 COMBINATION XBUILDING ❑ MECHANICAL U PLUMBING SIGN <br />OWNER IL ESS <br />FhMM ZI/P� PHONE <br />iltl1 A '7 /�p .D, Qox �YP6 `uoii1'?7ao,% �rr_Ilj. <br />V V,1[JJ <br />SYA M 2 <br />DESIGNER HAIL ADDRESS <br />MECHANICAL COLWIACTOR MAIL ADDRESS CI Y <br />No pi e. <br />PLUMBINOCONTRACTOR MAIL ADDRESS -CITY <br />Naf) <br />CONTRACT PRICE OF WORK <br />0 /7 .5-00 / Z 769 f <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />i arP.r G4ra9�� WA Cc <br />0,rfy <br />PRO 5,-Dy3 E OF BUILD <br />%�9 � Ny Recrea�icn - sFR <br />LEOAI OE/SJCM$7KYI OF PROPERW(SSHHOWJN�BELOW <br />�OR ATTACH O OPIESI <br />LOT- BLOCK <br />PARCEL TAX 1,13 .NUMBER <br />tPLUiMBING; <br />LEN 9.ADDRES NE NUMBER <br />in art <br />SS <br />`7--?.t A: r <br />"o fZIP PHONE STATE LICENSE <br />/A/a SeeI JC3TIP <br />PHONE STATE LICENSE v <br />ZIP PHONE 9TATE LICENSEI <br />i <br />CONTACT PERSON AND PHONE NO T N / <br />`rOt' /�7 N/r/`e /bc <br />' HEREBY CERTIFY THAT I 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 />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <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 I 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />saNATUBE w— n.�e <br />LHY BUSINESS II.. NO <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />m� II�Il1YML <br />FEE NO. TYPE OF EQUIPMENT <br />WATER CLOSET IT <br />A/C—A/HNDLG UNITS—H.P. <br />FEE <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I UNIT HEATERS—B.T.U. M <br />' <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />I <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />I WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />I <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' HEAT PUMP <br />, <br />PACKFLOW PR <br />; GAS PIPING <br />I <br />ROOF DRAINS—RAINLEADERS <br />I EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />— <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />_ I PERMIT $ <br />TOTAL FEE $ <br />' TOTAL FEE $ <br />I <br />rum vrncc EJAC VNLY: <br />FRONT SETBACK <br />REARSETBACK� <br />SIDE SETPFCI(� <br />/ <br />PLAN CHEC N M ER FEE <br />RECEIPT NO <br />Z /22. �� <br />LL <br />USE ZONE <br />A — � <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />BUILDING <br />!Q <br />— <br />G YES O NO <br />TYPE OF CONST <br />NO OF STORIES <br />IICCY/AIAY <br />No wMIT" All <br />PLUMBING <br />2_ <br />SIZE OF BIL <br />$5'Y JIB CAMun7 <br />FIRE SPRINKLERS REOD <br />BASEMENT <br />MECHANICAL <br />_�I <br />A 7 <br />O <br />❑ YES LK NO <br />OCCUPANCY LOAD <br />N<FIRE ALARM "Eau <br />HEIGHTLWITATKM/ <br />ADDITIONAL PLAN CHECK <br />i <br />L <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />PlANB A��BY <br />CITY I EVERETT <br />PUBLIC WORKSLOCAL <br />SALESDATE <br />TOTAL <br />8 /P'LI <br />TAX CODE IS 3105 <br />