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AiaPLICATII.N FOR CONSTRUCI .ON PERMIT �� <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> DUILDING DEPARTMENT <br /> 259-8810 <br /> �DEJ�IOUTION COMBINATION C�BUILDING MECHANICAL PLUMBING SIGN <br /> �( OWNE�- ^ �r I,IARIL A �RE55 _r �ITV � /� zIP FHONE <br /> �Ny-/aLTidJ /��0 �+-61 � {l� � a �"f' 9��0� Z.S.Z— .� g�f0 <br /> TENANT MAI�ADDRE55 �� � �CJiVr � IIP PMONE <br /> � 7 C9 <br /> ABLHRECTOR DESIGNEF MAIL ADDRE55 �ITV IIP PHONE <br /> GENE CONTRACTOH MAIL ADDRESS GTY ZIP PHpNE STATE LICENSE Y <br /> , Ci�/�G�_7 <br /> MECHANICRLCONTPRGTOR MAILADDRE55 CfTV ZIP PMONE STATELICENSEII <br /> PLU�dBING CONTRA�TOR MAIL AODRESS CITY IIP PHONE piATE LI�ENSE� <br /> CLASS OF WORK <br /> NEW . ADDITION ALTERATION REPAIR DEMOLITION � WOODSTOVE/FRPI INSERT . BUILDING RELOCATION <br /> /� WNTALT P[RSON AND PNON[NO. <br /> �WNTRACTPpICEOFWORK 0�� ,� <br /> DESGRI WORNANDS�ISAREFOOTAGEINVOLVEU <br /> L, t�� <br /> PROP seouseocew�oirv� � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��� � > L�,`.�_. .,q ,- �J ,�n� � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALDESCPIPTIONOF PROPERiY�SHOWN�ELOW OR ARACH FWRfqPIE�' PROVISIONS Of LAWS AND ORDINANCES GOVERNING THIS TYPE 0F <br /> WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br /> ior eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 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 CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL!CATION IS MADE AND I GOMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> .( "'�� 3 -�`�= P� <br /> ?ROJECTA�DRESS 9cm<tu pqi. � <br /> / �� � <br /> r�� /;Y��R�` uJ�Xti- . <br /> r.nv nusaas i�cnaF rvo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—A'HNDLG UNITS—H.P. I � <br /> BATHTUB � FORCI=D AIR SYSTEIdS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> - DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV ; WATER 11EATER � <br /> -.. <br /> CLOTHES WASHER � WOOD STOVE ; � ��-��1 <br /> URINAL METAL FIREPLACE 8 CHIMNEY �— - � <br /> DFINKING FOUNTAIN I FIREPL4CE INSERT ; .-.- <br /> FLOOR DRAIN HEAT PUMP �— � � -��" <br /> _. l - uf <br /> BACKFLOW PREVENTERS ; GAS PIPING ; � � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETC.) ; � <br /> � , <br /> � , <br /> � <br /> � , <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONT SETBFCN REAR SETBACK SIDE SETBACN PLAN CNECK N � FEE RECEIPT NO. <br /> 3�1� <br /> use zoNe LOT AREA VqCANT SItE FEES VALUATION FEE <br /> BUILDMG � �-- <br /> 1YPEOiC�9iSAlLOWABLE TYPEOfWNSi.ACiIIAL ottuvextr xodmvFuni4uNi�5 <br /> cnaur - p�UMBING <br /> SREOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL i <br /> OLCUPANCV LOAD FIRE SPRNKLERS NEO'0 HEIGHT LIMITpT10N ADDITIONAL PLAN CHECK � <br /> i <br /> SPFINKLER � <br /> REASON FOR SPRINKLERS ---r— <br /> S7ATE BUILDING SURCHARGE � <br /> INTFNE BI' PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> TAX COUE IS 3105 TOTAL �� <br />