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'-ly�7 ti' <br /> APPLICATICC�11 FOR CONSTRUCT""1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> — -- — ------.— _ _ _ — <br /> BUILDING DEPARTMENT HEATING SYSTEM: .J GAS J ELECTRIC J .._ � '�' <br /> - -- ._.--- ' <br /> 259-8810 � <br /> DEMOUTION COMBINATION �Y.r BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER� MAIL ADDRESS � CITY --_- Z'P --�"� PHC> f:_. <br /> �����e� 41UAl�e� �P,,� A ?8203 ��i � 2—�ZuS <br /> ?ENANT MAIL AODRESS CI��V dV PHONE <br /> ARGNITECTORDESIGNER MAILAOpRESS CITY 21P PHONE <br /> GENCRAL CONTRACTO'R� 7 MNIL A�ORE55 � F i Y ZIV �� PHONE STATE LICENSE Y �w� <br /> rr2cisio-w Wao o � /�(7, ��C/�//2 �,-r.t�i BFUA/r lUR 5" � /��7% T�IZEG�wI,D��]i 'N <br /> MECHANICAL CONTRACTOR MAI�qDDF 55 CITY ZIP PHONE STATE LICENSE X <br /> PLUMBING CONTRACTOF MAI�4DDRESS CITY ZIP PHONE STATE LICENSE t <br /> CONTRACT PqICE OF WORK <br /> �ESCRI6E WORR ANC SOUARE FOOTAGE INVOLVEO CONTACT PEfiSON AND PLIONE NO. <br /> /�(�� re�-r2 <br /> i HEREBV CERTIFY THAT I HAVF R�AD AND EXAMINED THIS <br /> vaoaoseo use oF sui� Ne, APPLICATION ANU KNOW THE SAME TO BE TRUE AND COFiRECT.A!L <br /> �� i " '� PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS T�PE OF <br /> �ecn�oeswiarioNOFcaoaearvisHowNae�owoanrrncr+rwoeoPiesi WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iar e�ocK oF NOT THE GRANTING OF A PERMIT DQES NOT PFlESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �, <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CGNSTRUCTION.THAT I AM AUTHORIZED BV THE �I <br /> OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH '� <br /> APPLICATION IS MADE AND I COMPLY WITH THE S'ATE <br /> PARCELTAXID NJMBER Ii <br /> (7COS OOp p I OC7 Oy CONTRACTORS LAW 1827/pCW AND 296200 WAC. <br /> CONSTRUCTIONIONNLENDER. DPESS,TELEPHONENl1MBER �ep/f/p�y (/�3dc/W3�Li� l - . / '� <br /> � � � � � � �� <br /> PROJECT ADDRESS s�cH u��e on e ' <br /> c vaoswcssu ms No � <br /> � PLUMBING MECHANICAL �I <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE ��� <br /> WATER CLOSET(TOILET) A/C—NHNOLG UNITS--H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � •J <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.LL M ' � <br /> � SHOWER � CLOINES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> �ISHWASHER RANGE HOOD � <br /> LAUNDRY TFAV WATER HEA7ER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WO00 BURNING) _ .� <br /> _ DRINKING FOUNTAW FIREPLACE INSERT .�� <br /> FIOOR DRAIN HEAT°UMP � <br /> _ BACKFLOW PREVENTERS GAS PIPING � q <br /> ROOF DRAINS—RAINLEADERS EXHAUST fAN � <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br /> . — — — � <br /> SUB TOTAL $ — SUB TOTAL $ � <br /> PERMIT $ PERMI7 $ <br /> TOTAL FEE $ TOTFIL FEE $ <br /> FOR OFFICE USE ONLY: _ l <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK P�AN CHECK NUMBER PEE RECEiPT NO. <br /> usezoNe �ornaen vacnrvrsire FEES VALUATION FEE �� <br /> �..�-. VES �.; NO BUi�oiNG <br /> lYPFOfCONSI NO.OFSTORIES OLL'JCPNtv rvaOfpWELLiNGUV35 - — — <br /> cvouo PLUMBING <br /> SiZEOFBLDG FlRESPRiNKLEFSREOD BASEMENT MECHANICAL � <br /> .�- VES -.� NO � <br /> OCCUPnNCY LOA� FlaE A�nqM REO�o HEIGHt uMITnTION ADDITIONAL PLAN CHECK <br /> OTHER <br /> REASON <br /> STATE BUILDING SURCHARGE ' <br /> INTAHE BY I P�ANS APPROVED BV CITY Of EVERETT PUBLIC WORK$ <br /> IOCAISALES <br /> oA,e TAX CODE IS 3105 TOTAL <br />