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APpLICATIO. FOR CONSTRUCTI^N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br /> BUILDING DEPARTMENT HEATING SYS7EM: r)GAS ❑ ELECTRIC J —� <br /> 259-8870 <br /> DEMOLITION L I COMBINATION f- BUILDING i MECHANICAL t1 pLUM81NG i , SIGN <br /> OnW1:EP MAILADDRE55 CIiY lIP PHONE <br /> �/,Q. �r10/Ee z/� �z CO/!3Y /Jl/" �✓c-cEA 9S�J4/ �25'9-/7 �! <br /> TnENA�Ni MAI�ADDRE55 CITY ZIP PNONE <br /> �1d. Cp�crE� �Os''Z CULgY Al1� EvE� 9Y.ao! 2SS-�,�7r`f <br /> APCMrtf.CTORDE5IGNER MAILADDRE55 CITY ZIP PHONE <br /> GENENAL GO/RRACTOR MAIL ADL1RE55 qTV 21P PNONE STATE LIGENSE� <br /> MECHANIGAI GONTRACTOR MAIL AO�RESS QTY 21P PHONE SiATE L�CENSE� <br /> PWMBINGCONTRRCTOR MAILADDRESo �ITY ZIP PMONE STAiELICCN5E1 <br /> �Ar d �✓rtF P��r��� /-r/ l3Cx" �Od / • LYnnwaoo� 9£rOy6 35-3-Erib4 DAr,v2 P1077CU <br /> CONTR/CTPRICEOF WORK /s'8' D �✓ <br /> DESCRIeE WORN FN�SOW RE FOOTAGE INVOLVED <br /> T CG NCK GLOI,i ��(/ZCE CONiqCTPERSONANDPHONENO <br /> I HEREOV CEiiTIFV THAT I HAVE READ ANO EKAMINFD THIS <br /> PROPOSED USE OF�UILDING APPLICATION AND KNOW THE St,ME TO BE TRUE AN�CORFEC7.ALL <br /> PROVISIONS GF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGALOESCRIPiIONOFPROPERTY�SHOWNBELOWOFpTTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHEfi SPECIFIED HCREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PP.ESUME TO GIVE <br /> iot e�o:K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> QTHER STATE OR LOCAL LAW REGULATING CONSTRUC110N OR TNE <br /> PERFORh1ANCE OF CONSTfiUCTION.THAT I AM AUTHORIZED BV THE <br /> OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPIY WITH THE STATE <br /> cnRcei*nx i.o.NuueE� CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANL[NDEfl.A��9E55.iELEPHONENUMBER <br /> ,�, � 3/ay�9y <br /> PROJECT ApDRESS S�N+wi�e y�� o,.c <br /> cnv nuemras ucr r�st Hn � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. T1'PE OF E�UIPMENT FEE <br /> WATEN CLOSET(TOILET) A�G–A�HNDLG UNITS–H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS–B.T.U. M E.A. <br /> LAVATORV(WASIi BASIN) UNIT HEATERS–B.T.U. M ; <br /> SHOWER CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNINC� � <br /> DRINKING FOUN7AIN FINEPLACE INSERT <br />, FLOOR DRAIN HEAT PUMP � <br /> � BACKFLOW PREVEIJTERS T; GAS PIPING <br /> ROOF DRAINS–RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE–BAR,ETC.) ; <br /> �— <br /> � , <br /> � , <br /> � <br /> � � <br /> � _ <br /> SUB TOTAL $ �' ; SUB TOTAL $ <br /> PERMIT $ 2D � PERId1T $ <br /> TOTAL FEE $ ; TOTAL FEE 5 —� <br /> FOfl OFFICE USE ONLY: <br /> FflONTSETBACN REAPSETBAGN SIDESE?BACM. P�ANCMECNNUM�EB FEE RECEIPiNO. <br /> 115E ZONE LOT APEA VACANT SITE FEES VALUATION FEE <br /> �' VES ❑ NO BUILDING <br /> TVPEOFLONSi NO.CFSTONIF.S atUv�qp rNmpMUMGUNrts -- — <br /> . 09m'r pLUMBING <br /> $RE OP 910C� FIPE SPRINKLERS PEO'D BASEMENT �,�ECIIANICAL <br /> ❑ YES ❑ NO <br /> OCCUPANGYLOAD � FIREAIARMREOD MEIGHTLIMITAiION ADDITIONALPLANCHECN <br /> OTHER <br /> ' REASON —' '—�— <br /> STATE BUILDING SURCHARGE <br /> INTANE BY PlANSAPPi10VGO BV CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALF.S <br /> OATE TAX COOE IS 3105 TOTAL <br />