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I APPLICATIO�N FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIn f � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ —� <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> O M�AR}ADORESS ']�7 /� L/ITY� � n`'IIP , 1 ` �7P�NONE /Jc �/ <br /> X '� / �AURAD�fiS •l /D � " '/� Clll�-�/I VZl CC_U IeiTi) /�. `/n�L� <br /> TENANT <br /> •RCNITECTO{IDES�ONER AURADDRESS CITY ZIP PMONE <br /> 6ENEIULLCONTMCTOR MAIL�DDflESS CIiY 21P PHONE ST�TELILENSEI <br /> • <br /> MECNNIICALCONTMCTOR MAILADOHESS CI7V ZIP PHONE STATELICENSE� <br /> X•7� �Fac �� i�o � ��a,d,<< �o qes3� �as� szzz ?"�e.u,rpro�o� <br /> PLUMBINOGONTpACTOfl MA0.ADDPE55 /� ! i/-E�TY�2 ZIP PHONE STATE4GENSE/ �I <br /> V � /Y%�7c <br /> CONTRACT PRICE OF WORN �� <br /> DESCRIBE WORK AND SOU�RE FOOTAOE INVOLVED CONTAGi PERSON ANO PNONE NO. <br /> 2 <br /> I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOFOSED USE OF BIIILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEMl0E6CRIPTIONOFPROPERTV�51i0WNBELOW�IIATTACHTWOLOFIES) WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN(3 OF A PERMIT DOES NOT PHESUME TO OIVE <br /> ��T �O� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STA�E OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOflM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br /> PARLELTAIf I.D.NUMBER CONTH RS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTqN lWN LENOER.ADDRESB.TELEPMONE NUMBEN � <br /> _ G-i�- 9s <br /> PROJE ADDNE88 �"* °"rE <br /> I _r �m.�u����� <br /> � PLUMlINO MBCHANICAL � <br /> � NO. TYPE OF fl7fTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> � WATERCLOSET(TOILET) � AICrAIHNDL6UNITS—H.P. � � <br /> � BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> UVATOR'/(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � . <br /> I KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> � DISHWASHER � RAN6E HOOD � <br /> �— <br /> 1 LAUNDflYTRAY ; WATER HEATER ' <br /> j CLOTHES WASHER � WOOD STOVE i <br /> ' UHINAL ' METAL FIREPLACE(WOOD BURNING) �_ <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRA!N � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING ; <br /> ' ROOP ORAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' ' <br /> � � <br /> i � <br /> � <br /> i � <br /> � SUB TOTAL S ; SUB TOTAL S ' <br /> � PERMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE E —^— <br /> � FOR OFFICE USE ONLY: <br /> FRONTSETB�CN RE�RSETBI�CN 61UESETBAGN PIANCNEGNNUMBEN FEE HE PTNO. <br /> � ��� <br /> U6EZONE LOTAflEA VACANTSITE FEES VALUATION fEE <br /> �� <br /> ❑ YES ❑ NO BUILDINO � <br /> iYPEOiCONST. NO.Of&TOPIES aCwrxr WduMluuGwin � <br /> W°'� PLUIIBING i <br /> SIZEOFBLDO. FIflESPRINNLEfl5RE0'D BASEMENT MECHANICAL � <br /> ❑ YES CI NO ; <br /> OCCUVANcv LMD FIRE�W1RM flE0'D HEIOHT LIMITRIGW ADDITIONAL PUN CHECK i <br /> OTHER � <br /> � <br /> PEASON �— <br /> S7A1E BUILDING SURCH q0E <br /> IMAME BY PlANB�FP��qOVED BY CITY OF EVERETT PUBLIC WORKS � i <br /> �)m LOCALSALES <br /> oae �p� �j TAX CUOE IS 3105 TOTAL � <br />