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APPLICATIO�1 FOR CONSTRUCTION PERMIT � <br /> TO 8E C.. .�PLETED IN BLACK INK—PLEASE PRII. <br /> BUILDING DEPARTMENT HEATI�IG SYSTEM: ❑GAS D ELECTRIC O_ <br /> 259•8810 <br /> � DEMOLITION ❑ COMBINATION �BUILDING IJ MECHANICAL ❑PLUMBING O SIGN <br /> OWNER M�ILIODRESS CITY 21P PHONE <br /> ,(3o��Ns e.a, , Po. �eK 3 � a� , �s ot�--�?, S�c��rcE, w� • 9P�Zy 3yZ-�339 <br /> TEN�NT qLADDNE55 C�T� ZIP ° PHONE <br /> fjD L�/N 6 • <br /> �RCNITECTONOESIGNFR M4UppflE55 CI7Y ZiP pNONE <br /> TN�� .4��sr�� Ca� <br /> GENER�LCONiPeC70p MULADDRE55 CITY ZiP PNpNE STATELiCENSE� � <br /> SDL Co0.�. <br /> MEGN�NIC�LCONTPACiOR M�Y +DORE55 CITV ZIP PNpNE STATEUCENSE� <br /> VLUMBINOCOHTP�CTOR M�ILAD�RESS CITY 21P PMONE SUTE4CENSE� <br /> CONTR�CT PRIGE OF 1WRN <br /> Z�����0 <br /> DESGRIBEWORN�N06WAPEfQOT(��mOtCD�` ^�,n CONT�CTiEN50NAN7PHONENO. <br /> O R.UG Gfr l v �7 <br /> L<son��n,D STEM.BoaS,�l 266 .-3tGS <br /> I HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br /> anoaoseouseoreunon+a APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �l/LC21}fT Mf'fS� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> lEOALDESCRIPT10NpfPROPERiY�SHpWNBELOWONATTALNTYOCOilE51 WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> �or e�ocK or NOT. THE GRANTIN(3 OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW RE�ULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS Pi70PERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND 1 COMPLY WITH THE STATE <br /> PARCEL TA%1 D.NUMBEH CONTPACTORS LAW 18.21 RCW ANO 296.200 WAC. <br /> CONSTNUCTIONLOANLENUER.�DDRE65.TELEPMONENUMBER IL19��/ . U'/'—"""• ' !�J//9 <br /> y <br /> PROJECTADO ESS (,f, a .*unt o+�e — <br /> 3ao3 �• e,es,No ��, 7 �`� ' cnreusw[ss�c[riscw — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ,� � CLOTHESDRVERS �_ <br /> � KITCHEN SINK d DISP ; VENTILAT�ON fAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER i WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINNING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF OFAINS—F7AINLEADERS � E%HAUST FAN <br /> SINK,�ERVICE—BAR.ETC.) ; <br /> ' �— 1 <br /> � , <br /> � � <br /> � <br /> SUB TOTAL f SUB TOTAL E <br /> PERMIT S PERMIT E � <br /> TOTAIFEE S ' TOTALFEE E � <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBACM PEARSETB�CN SIOESETBA�N PL�NCNEC NUMOER fEE NECEIPTNO. <br /> �s�>a <br /> USESONE LOTARE� V�CNIT9TE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILOIN6 �/J fJ�(j'J _�D� ' <br /> tYPE W COH51. NO OF�T NES oaiv�rtr w�n mMuumuxiu <br /> N i � PIUMBING � <br /> -� <br /> 5�2E O BLD6. FIRE SVRINNLER:REO'0 BASEMENi MECHANICAL � <br /> T�I• I�S ❑ YES ❑ NO - <br /> O. UPANCY l �D FIP �L�RAt NE00 HEIGNT LIMIT�TION ADDITIONAL PLAN CHECK �.��� <br /> � S OTHER � <br /> � <br /> AE�S� --� <br /> STATEBWLDINGSURCNARGE �� y� <br /> INTANE BY ilANS�oP �or CITY OF EVERETT PU�UC WOFlY.S ' <br /> LOCAL SALES —�' <br /> o�re _�5. S� TAX COOE IS 3105 *� - ; <br />