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APPLICATI�._J FOR CONSTRUC7_JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> 259-6810 <br /> f7 DEMOLITION CI COMBINATION L; BUILDING IJ MECHANICAL CI PLUMBING ;}�SIGN <br /> OWNER MAIIA��FE55 CITV ZIP PHONE <br /> -ffl�i�nom��s 5ao io$-��, A�,e. p� . 3elle�r�a.e , wc,..q�6o�4 y53 -03�y <br /> TE�FNT MAILADDRESS CITV ZIP PHONE � <br /> I�at rC��F+e�� 4u� f U�erc�t-�o� I,tJC�M FNer�t} 1�9- I ��/ <br /> AflCHITECTORDESIGNER MAI�AD�RESS ZIP PHONE <br /> r <br /> GENEPALCONTNACTOii MAILA��FESS CITV ZIP PHONE STATELICENSEa <br /> . re.��ho.s;�,v� ►�O�Sr �(� vr�✓cti AVe IV SPl��lp, wGl � �3 5yd-�3�- Shn�^257- IIU,TG <br /> AIECHANICALCONTPACTO MAILAD�RE55 CITV 21P PHONE STATELICENSEN <br /> PLLIMBINGLONTRACTOR MqILAU�FE55 CITV ZIP PHONE STATELICENSEN <br /> � <br /> CLASS OF WORK <br /> �NEW L ADDITION C.I ALTERATION I_I REPAIR L I DEMOLITION I I WOODSTOVE/FRPL INSERT CJ BUILDING flELOCATION <br /> p CONTACT PERSON AND PHDNE NO. <br /> CONTRACT PRICE OF WORK �O ��J O ��— G �O �` <br /> DESCRIBE WOflK AND SOUAFP FOOTA�iE INVOLVED I <br /> I-�' n-c e -i <br /> PflOPO DUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> '�'�� I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAIUESCRIP�fIONOFPfiOPERTV�SHOWNBELOWORA7TACHFOURCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEReIN OR <br /> :oT e�oc oF 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 /> �� ONlNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> X ��4�L'r+'.vv Cl���� <br /> PROJECTADDRESS SicNniME oAiE � <br /> � �� w 3sl33 <br /> CIIV 6USiNE55 UCENSE NO. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FUfTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN i <br /> DISHWASHER � RANGE HOOD <br /> . LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE&CHIMNEY � <br /> DRINKING FUUNTAIN i FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RA�NLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> � � <br /> � � <br /> � � <br /> i i <br /> SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT $ � PERMIT 5 � <br /> r <br /> TOTAL FEE S ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACN REAFSETDACK SI�ESETB�CK PLANCHECNoNUMBEF FE�� � RECEIP��oa3 <br /> Y 9d �OS <br /> USEZONE LOTAREA VACANTSITE PEES VALUATION FEE <br /> �� BUILDING Q� a� i Q� <br /> TYPEOfCONiS.ALL4WABLE TYP'�FCONST.PCiUhL aCCUPANtY Nu.oiU�hEItINGUNrtS i <br /> cnouv � PLUMBING ; <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> i <br /> OCCUPANCVLOAD FIRESPRNKLERSFEOD HEIGHTUMITATION � " ADDITIONALPLANCHECK i <br /> i <br /> � I SPRINKLER ' <br /> i <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE i s(� <br /> . � <br /> INTpKE BY PLANSAPPROVED BY CITY OF EVERETT PUBLIC WOF7KS � <br /> LOCALSALES , <br /> �7 7 M TAX CODE IS 3105 TOTAL ��� <br />