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APPLICATIAN FOR CONSTRUCT'�ON PERMIT � <br /> TO BE COMPLc'TED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS O ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION O COMBINATION D;I BUILDING �MECHANICAL 5�J PLUMBING pD SIGN <br /> OWNEH AV�RADDRESS LITY ZIP PNONE <br /> �N�-�-�-+�����IJa�k�'+✓i- 7(ayL �.2. lv2u�.. i3�N.,eU l�4 9fs'�oll <br /> TENMIT MAIIADDRESS CIN IP PHONE <br /> �nlc.� �,D i59� ���Q�� �� c2�. 9Qoz� --�yr-zss91 ��?s-����9 ' <br /> ARCMITEGTORDESIGNER MAILADDRE55 CITY ZIP PNONE <br /> ��11 L���;�k.. 15 9�`3 C�s"11 (1.�24J GzvJ q°zo2C-. '7 �/S� 2�9� '_ <br /> GENER�LCONTRALTOR AURADDilE55 CITV 21P PNONE STFTEIICENSE� <br /> �a�-��—��i - TC��n N��- <br /> MECM�NIGALCONTMCTOR 1MIL�DDHE55 GTV ZIP P:1pNE STATELICENSEt <br /> � / <br /> C <br /> PLUMBMGCONTRACTOR MA0.�DOflESS CITY ZIP PHONE STFTEIICENSE� <br /> \ / <br /> CONT GT PRICE OF VNAN <br /> �1U- l ' .� <br /> OESCRIBEWORNANDSOU REFOOTACiEMVOIVED WNTACTPERSONANDPHONENO. <br /> �S k � G� u�t�-ht To <br /> ' -r,�� .� ' �� l �1 �,.-F-� 7Y�"� ZS 9 <br /> 2s I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> ra000seo use oF eu�oirx; APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEWLOESCRIPTIONOFPROPEXTY�^NWNBELOWORAIiACMTYOGOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot- �9� Z� e�ocK--��L oF 2a�c IL�Z.-�i ( f* NOT. THE GRANTING OF A PERMIT DOES NOT PFlESUME TO G�VE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROYISIONS OF ANY <br /> �l a-E v��- �-�(t1�'tLt77 VOI�Z O�L 1�' -fS OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZFD BV THE <br /> 7 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOA WHICH � <br /> \ ol Sud. �h • -F APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARGELTAXIO.NUMBER CONTRACTORS LAW 1B27 RCW AN0296200 WAC. <br /> CONSTRUCTIONLO�!lLENDER,ADDPESS.TEIEPHOVENUM9EH <br /> Y �., � ,�. 9/s/�3 <br /> PR0.IECT ADDilEBS sw�aune o�re <br /> att eusaess icErisc r+o <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FlXTUNE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATEH CLOSFT(TOILET) � IV�ARiNDLG UNITS—H.P. <br /> BATHTUB � � FORCED AIR SYS?EMS--B.T.U. M E.A. ; <br /> �< LAVATOtiY(WASH BASIN) � � UNIT HEATERS- ��1,.�� /.�^y-� I <br /> SHOWER ' OTHESDRYE �""'�rb�—��'^,"� �— <br /> KITCHEN SINK 6 DISP � ; V TILATION F ��I r�i� T_ I <br /> / DISHWASHER � RAN HOOD I�/ A/1 1 ��'//�A ' � � <br /> IAUNDRY 7RAY ; WATER EATE' ���«��� � ��V��NV ' <br /> CLOTHES WASHER � WOOD ST E � <br /> URINAL ' METAL FIRE � ; <br /> DRINKING FOUNTAIN � FIREPLACE IN � <br /> FLOOR DRAIN � HEAT PUMP —r <br /> BAC.KFLOW PREVENTERS ; GAS FIPING ; <br /> ROOF DRAINS—RAINIEADERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ' � <br /> i <br /> � <br /> � � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT $ 2O� PERMIT S � <br /> TOTALFEE $ ' TOTALFEE E <br /> FOR OFFICE USE ONLY: U� <br /> FRONTSETBACN RE�fiSETBACK SIDESETBACK PLRNCNECKNUMBER — FEE __.� NEC TNO. � <br /> r�j <br /> USE20NE LOTAREA VALRNTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> iYMOlCONST. N�.OFSTORIES Ottuoexcr xoaoxFlU�tmit6 i <br /> �aa0 PLUMBING i <br /> SIZE OF BLDG. FIRE SPPINKLERS P�EO'D BRSEMENT MECHANICAL � � I <br /> ❑ YES ❑ NO � <br /> OCCUPANCY LOAD FIRE�LwRM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> � <br /> OTHER � <br /> REASON i <br /> STATE BUILDING SURCHARGE � <br /> INTANE 9Y PLANS RPPROVED BY CITY OF EVERETT PUBLIC WORNS i <br /> LOCAL SA�ES , <br /> DR7E TAX CODE IS 3105 TOTAL 133 �'- <br />