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APPLICAT10�1 FOR CONSTRUCTIAN PERMIT � <br /> TO BE C���iPLETED IN BLACK INK—PLEASE PRIN i <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDINC3 ❑MECHANICAL ❑PLUMBINQ ❑ SI(iN <br /> OWN/E�N� M�II��j�RE54 ,,� /CITY ZIp PNONE <br /> ,Vv6/N6 'Lo� / YO. �OY37 �7 � ,"YSOIf–/�, SCSA7l�Gr Wi4 • 9��Ly 3yZ'��3�9 <br /> TENANT �Il�DONE55 CITY ZIP � VMONE <br /> �D IS/N 6 • <br /> �FCNIfECTOR0E51GNER M�I�A�ORE55 CITY zIP PHONE <br /> TH�r �fiST/N L�a• <br /> OENERALCONTH�CTOP MAIL�DDRE55 CITY zIP PHONE 6UTELILENSE� <br /> SA1. Go�P. � <br /> MECMANICALCONTPeCiOR MAI��DORESS CITY 21P PIqNE ST�TE4CEN9E• <br /> PLUMBIN6CONTRACTOR M�RADDHE55 LIiY ZiP PMpNE ST�TELICENSEI <br /> CONTRACT PRICE OF WOAN IQ�p oOO <br /> ia <br /> DE6CPIBEWOR���AREfQO?�.6§,I�OEV��L ^�,n CONT�CTPEP90NANOPNONENO. <br /> cns «, � �� <br /> l�so�v�n,D TE'µBost�l 266 .-3s�s <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROFOSEDUSEOFBIllIDINb pppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> //LG2��f IKItb• PROVISIONS OF LAWS AND ORDtNANCES dOVERNINO THIS TVPE OF <br /> LEOALDESCN�P110NOFPqOVEPTYISNOVMBEIOWORATTACNTWOCOPIES� WOFK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> �or� e�aK ar NOT. THE GRANTINO OF A PERMIT DOES NOT PpESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCIIUN.THAT 1 AM AUiHORIZEO BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> P�RCELTAI(10 NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B27 RCW AND 296.200 WAC. <br /> CONSTNUCTIONIOANIENDEA,A�ONE65.TElEVNONENUMBER ' D <br /> �• 9 /y� y <br /> PRQ JECTA�DA ESS 6 �IWE n.rc <br /> Soc3 W� CAt�.�o �D. �0"ZI CRY�UfWlffIKFNSEW <br /> PLUMBINO MECNANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) � A!C–A/HNDLG UNITS–H.P. � <br /> BATHTUB ' FOFCED AIR SYSTEMS–B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS–B.T.U. M ; <br /> SHOWEF , � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> OISHWASHER RAN6E HOOD <br /> LAUNDRYTRAV ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> ORINKIN6 FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> HOOF DRAINS–RA�NLEADERS � E%HAUST FAN � <br /> SINK(SERVICE–BAR,ETC.) ; <br /> � <br /> � i <br /> � <br /> SUB TOTAL S ; SUB TOTAI S ' <br /> PERMIT E � PERMIT S � <br /> TOTAI FEE S ' TOTAL FEE S � <br /> FOH OFFICE USE ONLY: <br /> FPONi5ET0�LN PE�RSETBACR SIOESETB�CN P�ANCHECKNUMBER FEE RECEIPTNO. <br /> 55 <br /> USE20NE LOT�REA v�curtsirE FEES VALUATION FEE <br /> ❑ res C7 No Bw�owo _�C�(, ; 00 <br /> 1YPf0�CON5i NOOFSTOBIES ortuwtr wnpmvlui�wuxna <br /> � _^/ � ' PLUMBING <br /> � <br /> 52E Of B100, FIqE SPRINNLERS REO'D I BAS MENT MECHANICAI. � <br /> 7 y'.l. IE ❑ YEF, ❑ NO p <br /> OCCUPu1CYL A� FiRE�URMREO'0 HEIGM�LIMIT�iION ADDITIONALPLANCHECK �Q U � /U <br /> 4 YES � <br /> OTHER ' <br /> i <br /> RE�SON -—T <br /> STATF.BUILDING SUPCHARGE (� i�� <br /> INTANE B� Pl�NS�PPR EO BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> o��E _ ,s. g� TAX CODE IS 3105 rorn� � <br />