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��� APPLICATION FOR CONSTRUCT�ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ELECTRIC O <br /> 259-8810 <br /> I�� DEMOLI't10N ❑ COMBINATION j�BUILDING L;MECHANICAL C, PLUMBING C SIGN <br /> OWNER M�R/�DDRESS CrtV 21P P110NE <br /> ��� BoEi�� �� l?o. 6ax 37�7 M�5 ��-�c .Ss�-,rt�'. w�. 9Ri2� 3pa-.s��P <br /> TENGM M�IL DRE56 OITY I�� <br /> '1yF� �oE7NG Go . <br /> 11RCHREC70ROEBqNER M�ILIIDDRE55 /�� CRY ZIP PIq11E <br /> ,r/f� Mlsr"inr ev. ��cis- -/7n /1v�, w• , �vs,c�.�-7T" Wi4. 9p2oy x9a - 9i7-y . <br /> OENER/LL CONTMCTOR r M�IL�DDRESS � CITY ZIP P110NE BbRE LICENSE� <br /> SMvi 5 /�-5 �t:'yr G N S n� <br /> MECNN/ICAL CpITMLTOR M�IL�DDRESS CITV ZIP P110NE BT�TE LICENSE� <br /> %.UMBMO I:ONTN�CTOR M11R�DORES6 C�TV IIP PMONE BTATE IICEN9E� <br /> CU890F W011K I <br /> i � NEW ❑ ADDITION �i ALTERATION i. I REPAIR I.I DEMOLITION !.� WOODSTOVE/FRPL INSERT [i BUILDINO RELOCATION <br /> Cq1TAGT PERSON M!U PMONE NO <br /> ca+rw�cr m�ce ov wonK .i a�' a o o L.�o N 2. Lrh7 2 � I <br /> OE6CRqE WO�IM�ND BOUARE FOOT�OE INVOLVFO ' <br /> C:a ��rEti .t�.� y�� y sf 1G b-3s"63 <br /> PROPOSEDWEOFBUILDINf3 i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TMIS I <br /> GoM Pv-E2, /L.odn� yu—3 3, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL il <br /> LEML OESCRIiTION OF PROPERTV�SMOWN BELOW OR ATTACM fOU COPIE6� PROVISIONS OF IAWS AND ORDINANCES 60VERNINO THIS TVPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR I. <br /> �or e�ceK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE ' <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �. <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE II <br /> OWNER OF THIS PROPERTY TO PERFOHM THE WORK FOR WHICH �� <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 288.200 WAC. <br /> �-n-�+f �, �r ,�e� ' S��ZZl9y <br /> x ' <br /> PR0.IECT�DONES6 6Ux�r�qE � wt� �II <br /> 3aC13 �N• CA'Sin/p 2p, �0-33 cmeus.�ce�i�cewsFw <br /> PLUMBIN6 MECMANICAL ��.� <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE I, <br /> WATEH CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIH SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDHVERS _ <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV ; WATER HEATER <br /> CLOTNES WASHER � WOOD STOVE <br /> URINAL ' METAI FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> qOOF ORAINS—HAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAq,ETC.) � <br /> � � <br /> � � <br /> � T <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S � PERMIT S <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONi6ETB�CN NE�RSETBACN SIDE6ETB�CK PUNCMEG1tNVMBER FEE REGEIPiNO <br /> 3�-Y�/ �� <br /> USE 20NE l0T I1PE� V�C�NT 6iTE FEES VALUATION FEE <br /> 6UILDING S00 C 0 O ',�0 <br /> 1vPE M LONTS Ml0'yMlf TYRi i CONST.�LN�I occwxc. w a vwtuwc uM�n i <br /> � A I PLUMBING i <br /> �V � <br /> SIZE M BLD(i NO.OF 6TOR�ES BASEMENT MECHANICAL <br /> Lj 4. <br /> i <br /> OGGU Y LOAD FIRE SPANNLERS RE09 MEI6NT LIMIT�TION �L PUN CHELK � ) � � <br /> i <br /> Y�J SPRINKLER ' <br /> , <br /> REI15JNi RSiRINKLERS i <br /> �p��� ST�TE BUILDING SURCH�RGE <br /> WTAKEEY PU �PVROVEDBY CITY OF EVERETT PUBIIC WORKS � <br /> /� LOCAL SALES <br /> , TAX CODE IS 3105 TOT�� 3j 3� 9 �6 7 <br /> - ---��� <br />