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APPLICATIC �� FOR CONSTRUC7-7N PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMEh7 HEATING SYSTEM: ;J GAS �1 ELECTRIC J <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL x pLl!!dBING SIGN <br /> OWNE / '//�.�� �I�AM�ApDPE55� � � iiV ZIP PHpRE �7 ' — <br /> � � -� /-lJ/J � �„'�"� )n'h'S� C����2 ',� ,✓ "I �A�7r�'/5 /�� � <br /> TENANT MAILAODRE55 GITY ' zlP PHONE <br /> AHCHIiECTORDESIGNER MAILADDPE55 QTV ZIP PHONE <br /> GENEkALWNTqAGiOR MAILADDRESS �ITY ZIP PMONE STATELICENSEY <br /> MtCi:�YICALCONTRACTOR 1lAILADORESS CITY 21P PHONE STAiEUCENSEM <br /> \ <br /> PLUMBIHG CONTRACTOR MAiI�DDRE55 qTV ZiP PHONE SiATE LIC[NSE e <br /> n <br /> �_�1"/� F-- <br /> CLA OF WORK <br /> _NEW x ADDITION ALTEtiATION REPAIR OFMOLITION WOODSTOVE/FRPI INSERT �. BUILDING RELOCATION <br /> GON ACi^Efi ONANDPHON�1�10 <br /> �/� / � <br /> CONTRAGT PFICE OF WORK 9 � F � �t (J �i�'(J i��7 [:j� <br /> OESCRIBE V/ORK AND SOUAPE FOOTAGE INVOLVE� <br /> �/�rc�.l'F /Juo .'/ G�i�— >C.�tY.s �7 / S <br /> PROPOSE�USEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ nt:n EXAMIN D THIS <br /> �u-�a 2r.-,�C.t:a.. APPLICATION AND KNOW THE SAME TO BE TRUE ANG CORRECL ALL <br /> �ecn�oescRiaTi Of VRpPEFTV I5H01VN BELOW OR ATTpCHFOUfl COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL 9E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING Cf A PERMIT DOES NOT PRESUME TO GIVE <br /> AUlHUNl7'r TO VIOLI,TE �A C„NCEL THE PROVISIONS OF ANY <br /> _ OTHER STATE OR LOCAL LAW REGULATlNG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONS7RUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PPOPEqTY TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS MADE AND I COMPLY WITH THE STATE I <br /> CONTRACTORS LAW 1827 R W AND 296.200 WAC. <br /> �� �� / `� <br /> ___�(. ''� ' �`t r� / � <br /> PRq1ECTADDRE55 � s,vnr�in[ <br /> �tE <br /> 2 7 � �'� '� /i� "A i / �.rvnuswvssucrr�acrvo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE R ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) 7 r !uC—AiF�NDLG UNITS—H.P. <br /> BATHTUB ; FORCEJ AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) I— UNIT NEATERS—B.T.U. M ' <br /> [ � <br /> SHOWER CLO-iHESDRVERS (-cCc — <br /> KITCHEN SINK&DISP ; VENTILATION FAN � <br /> DISH WASHE(i RANGE HOOD �— <br /> LAUNDRY TRAY ' / WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL � METAL FIREPLACE&CHIMNEY � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � <br /> ROOF 09AINS—RAINLEADERS EXHAUST FAN � , <br /> SINK(SE(iVICE—BAR,ETC.) J� � <br /> � <br /> � — <br /> � — <br /> — � �— <br /> SUB TOTAL 5 ; SUB TOTAL $ /J'� ' �' <br /> PERMIT $ pd PERMIT $ i <br /> TOTALFEE $ � � — TOTALFEE 5 � <br /> FOR OFfICE USE ONLY: <br /> FRONTSETDACK RE�RSE'BAGK SIDESETBACK PLANCHECHNUMBEP FEE RECEIPiNO. <br /> X - ?��6� <br /> USEZONE tu-nrtn VqGANTSITE FEES VALUATION FEE <br /> BUILDING � <br /> iVPEOFCONTS.AIL�WABLE I\PEOfC:Y51AC1�AL oauneNn kaa�mv[wuG�xus — <br /> LPO°' pLUMBING � <br /> y/ iop <br /> SIZE OF BLDG. NO.OF STORIES BASEMENT MECNANICAL �� � p d <br /> OCCUPANCYLOAD FIPESPRNKLERSREOD HEIGNTLIMITATION ADDITiONALPLANCHECK � <br /> i <br /> SPHINKLER i <br /> REASON FON SPRINKLEPS <br /> STATE BUILDING SURCHARGE � <br /> INTANE BV PL�NS APPPOYED�Y CITY OF EVERETT PU6LIC WOFiKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL � <br /> - s� o0 <br />