Laserfiche WebLink
APPLICATI� FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS J ELECTRIC J <br />259-8810 <br />� DEMOLITION COMBINATION BUILDING ECHANICAL i PLUMBING SIGN <br />OIVN[F ldARAD�RESS CITV ZIP PHONE '/ <br />I�9ASea3 it�� O�yn�ie ,c'aissr-T y'� ' �l�'� <br />i[AA'IT MAIIADOqC55 GiY ZIP PHONE <br />ANa111TECTOR�E5IGN[H MAIL/DOqE55 <br />GENER4LLONiRAGTOR MAILADpR@55 <br />ZIP <br />CITY ZIP <br />PNONE <br />PNONE STATE <br />IAECNANICAtCONTR�GTOR 11AiLADOHE55 CITY ZIP PHpNE STAIELICENSE• <br />SN►. SffGs.T M<raL S7l2 d� �7` .�F. Ea.a,�..'� 3Jy3i�7 SueN�ro 0 P3oS <br />PLUMBINGCpNTRr1CTOR MAILApORE55 CITY ZIP P��ONE STNELILENSEv <br />CONTRAGT�'fiILE OF WORK <br />�ESCRIB� RK/1G� FOpTAGE � LYED <br />�1if.�T I N't 7J�/J�.�JI� _ <br />PROPOSED USE OF BUILOING --� <br />LEG�I DESCRIPTION OF pqOPERtt �SHOWN BELOW OR ATT�GN TWO COP1E51 <br />l01 �LOCN OF <br />P�RCELTA%10 NUMBER <br />CONSTRUCTIONLORNL[NO[R.ADDFESS.TELGPHONL NUM9ER <br />22o pLy,,, �,� <br />PROJECTADDRESS <br />PLUMBING <br />NO. TVPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN�__ <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENiERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRON�SEI9ACH R[Aq SEiBACK <br />use zorvE <br />IYPE Of CON57 <br />52EOFBLDG <br />OCCU'ANCYLOAD <br />REASON <br />iNiAKf 9V <br />SUB TOTAL $ <br />PFRMIT 5 <br />TOTAL FEE 5 <br />LOT AREA <br />NO. OF SiOR1E5 <br />FIRE SPRINKLERS REO'� <br />FlR[ �L�RM RGOD <br />PLANS ����10VC� 6Y <br />DnrE <br />SIDE SETBFCH <br />� � YES � ��. NO <br />ns�.,vnrvCv em crmv[w�ro.,na <br />�ooun <br />BASEMENT <br />YES NO <br />H[iG�il LIMliqilON <br />CITY OF EVEflETT <br />LOCAL SALES <br />TAX CODE IS 31D5 <br />ANp PHONI NO <br />f� <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AL� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI 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 I COMPLY WITH THE STATE <br />CONTRACTORS LAW �827 RCW AND 296200 WAC. <br />NO. . I TVPE OF EOUIPMENT <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOJSTOVE <br />METAL FIREF�ACE (WOOD <br />FIREPLACE INSERT <br />�IEAT PUMP <br />GAS PIPING <br />E%HAUST FAN <br />PL4N CNECN NUMBE R <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CMECK <br />OTHER <br />STATE BUILDING SURCHAflGE <br />PUOLIC WORKS <br />TOTAL <br />F[E <br />TOTAL <br />5 ; <br />$ <br />S <br />RECEIPT NO <br />FEE <br />�� <br />� <br />� <br />