Laserfiche WebLink
APPLICATIC-1 FOR CONSTRUC'T' lN PERMIT �✓� <br />TO BE COMPLETED IN BLACK INK—PLEASE F'RINT � <br />HEATING SYSTEM: J GAS J ELECTR�C U <br />BUILDING DEPARTMENT <br />2,ri9-8810 <br />DEMOLITION ' COMBINATION <br />01tir:Ea MAILADDRESS <br />W�11i+��„ SLvaN 72vS 58�'S <br />IENANI MAILADDRE55 <br />�4[.T�oNiCS l�o� N• Beop� <br />APCNITECTOROESIGNEF MAILA��RcSS <br />)( BUILDING <br />CIiY <br />QTV <br />:�ep <br />crtv <br />MECHANICAL i , PLUMBING <br />ZIP PHONE <br />4atza �s3-4z7� <br />21P PNONE <br />Tr B- 3 Z S.ti. =!D 71 I <br />Z�p PNONE <br />13 3 -4o Z <br />STATE LICENSE n <br />i SIGN <br />GENEfiALGONTRACTOR IAAIIADDRE55 �'^ "' "'--- <br />luE �f��,BoN STEFcH�Dc. I'l�q � ANv6eSoN RD �IT VEQ�IeN 4$Zry3 �Z�-4ollo BLUEFSB �,�1 LL <br />IdECHFNiCALGONTRACTOR MAILAUDRE55 CITY 21P PHONE STATELICENSEk <br />PLUA�/�NTPACTOii IAAIL ADORE55 CItY ZIP PHONE STATE LILENSE � <br />1� <br />CONTRHGT PRIG�F WORN � O ' <br />� �l �� i�� 2n - <br />ncsf.RiaF wOPN AND 50 AR2 FOOTAGE �NVOLVEO CO TACT PERSON ANO PHONE ND. <br />-- - �.. �� �1_ _�. c��..,.����� 1_Rni�-%RL-85/3 <br />% <br />PFOPOSED USE OF BUILDING <br />1�iaQ�lNEn D'� 1�K1�n 1 E I��y. <br />LEGAL DESGRIPT10Y OF PROPERTV ISMONRJ BE1014 OR ATTACH TWO COPIES� <br />LOT BLOCN OF <br />PARCELTA%ID.NUN�EB <br />qos az-14(� -oob� <br />GONSTPUGTIOHLOANLENDEP,ADORESS.TELEPN <br />PROJECT ADD�qESS <br />l�ol /J. �2owDuJa <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />LAVATORY(WASH dA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF DRAINS—HnINLtnVt <br />SINK ISERVICE—BAR. ETC.) <br />NUM�ER <br />Evc' lPE7%� <br />SUB TOTAI <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY; <br />FRONTS[TBACK REAR SETBAGK <br />�- �� � <br />US[ZONE LOTAREA <br />� '� <br />ivPE Of rCOG�Si�. NOAF STORIGS <br />-1�/ � <br />SIZ[� 7OF BLDG FIRE SPRINKLERS REQD <br />,.�.�' I�v i nGe'n� FIRG ALARI�EO'D <br />REASON <br />rt�rnHe ov r�nr+s n� oveoev <br />oni� �/3/cf9 <br />3 <br />I HEtiEBY 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 SPECIFIFD HEREIN OR <br />NOT. THE CRANTING 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 />PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAUE AND I COMPLY WITH TNE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />( / ,,,, Z.��.� _,._�, 4-zv-9¢ <br />nusirvc <br />� FORCED AIR SYSTEMS—B <br />; UNIT HEAI"ERS—B.T.U. M <br />� CLOTHESDRYERS <br />� <br />' VENTILATION FAN <br />r— ftANGE H000 <br />� WATER HEATER <br />, WOOD STOVE <br />� METAL FIREPLACE (WOOC <br />; FIREPIACEINSERT <br />HEAT PUMP <br />' GAS PIPING <br />� EXHAUSTFAN <br />JESETBACK FLANCHECNNUMEEF FEE <br />,o� <<�-� <br />�CANT SITE FEES <br />l 1 VES � NO BUILDING <br />CuoAS[r xoorpW¢pNr�vu:ls <br />� i P �' PLUMBING <br />�SEMENT MECHANICAL <br />❑ YES � NO <br />:IGHTLIMITATION ADDITIONALPLANCHECK <br />3S , OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CO�E IS 3105 rorn� <br />M E.A. <br />TOTAL S <br />v11T S <br />\L FE6 5 <br />7J!" FE <br />_ , <br />JATION <br />?D, 00 <br />