Laserfiche WebLink
TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT - CHFATINn CVSTCtb <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />"R I I MAILADDRESS <br />n7 <br />cw%#4DT PRICE OF WORK <br />Ll BUILDING <br />zip <br />CITY =IP <br />❑ PLUMBING <br />❑ SIGN <br />FOOTAOB VED ._- <br />CONTACTPERBCNµ HONENO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PR POBEDUSEOFBVILWO <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />lE aECRMTbN�PPRO►ERT'IE/K)WNBElOW011ATTACNTW000PIEEI <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOTBLOCK 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 I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />T <br />� (// 1-)n On 7' 50V <br />PAADEL TM LD. NUMEER <br />CONTRACT9RS .27 RCW AND 295.200 WAG. <br />�pw�� <br />PROJECT ADDRESS <br />ao ATF <br />r <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 TOILET <br />NC—NHNDLO UNITS—N,P. <br />BATHT <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATOR WASH BASIN) <br />UNIT HEATERS-8 T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK ISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />r <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN \ <br />HEAT PUMP <br />�— <br />SACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS \ <br />EXHAUST FAN <br />SINK SERVICE -BAR, ETC.) <br />- <br />1 <br />� <br />1 <br />1 <br />SUB TOTAL f <br />SUB TOTAL f <br />1 <br />PERMIT f <br />_ <br />_ <br />PERMIT f <br />��� w�e•Iw� <br />TOTAL FEE f <br />. <br />TOTAL FEE <br />r vn vF UIW& WQ& V"L.T: <br />FRONT SETBACK REAR SETBACK BIDE SETBACY <br />►Iµ CHEC NUMBER FEE <br />RECEIPT NO. <br />uaEZONE <br />LOT AREA <br />VACANTwE <br />FEES <br />VALUATION <br />FEE <br />7 YES NO <br />BUILDING <br />TYFE OF CONBT. <br />NO OF STORIES <br />O[currYLr Mp pCA1R�Y4 VY'll <br />PLJMBING <br />Pa1M <br />BIa OF Km <br />FIRE&PREMIEM RE09 <br />WlMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />OCCU►NlCY LOAD <br />FIRE ALARM RE09 <br />HEIOHT LIMITATION <br />ADDITIONAL PLAN CHECK <br />1 <br />1 <br />OTHER <br />i <br />REASON <br />STATE BUILDING SURCHARGE '' <br />1 <br />INTAKE BY _7IlAN9 AR►ROVED BY CITY OF EVERETT <br />ka <br />LOCAL SALES <br />PUBLIC WORKS <br />TOTAL <br />I <br />ATE TAX CODE IS 3105 <br />