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� APPLICATIQ'�1 FOR CONSTRUCT'''1N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � I <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ELECTRIC ❑_ <br /> 259-8810 <br /> I I DEMOUTION i_� COMBINATION �( BUILDING T. /, 1 1 MECHANICAL 1=i PLUMBING �� SIGN <br /> OYMEfi lAAIL ADOPE55 �ITV 21P PNONE <br /> JnN �,�ovP ��3� ����aQ� Avf. S,svv �vFUFrr,li.d� �s2ai 3£s�s-5`�oa <br /> TEflANT MAILACDRESS CITV 21P PHONE <br /> ANr�iC�a�u f�v�r��z 33o5oRK�5 A�. fVf/ZfTTW9 �/fJ2o�o �sz- s��� <br /> APCMRECTOR�L9GY.ER MAILADCPE55 �RY 21P PHONE <br /> �.lD�� 7SU�l�F1f�K/ (�D� T�l�F2�• yPflti��41t� �18/0/ Z�Z-f32o3 <br /> GE�G O��J� �SDAI RicNi��r15 �r�. 5�� IJL�CEV�I G�%r!i�OW7 lp�H9OC� STATE LICENSE P <br /> MECHANICALCONTPACIOR MPILAII�RESS CITV ZIP PHONE STATEUCENSEI <br /> PLUMBINGCONTRACTOR MpILADDRE55 CITV Z�P PNDNE STFTELICE45E� <br /> C017RACTPqiGEOFWOFON � <br /> ZGS! X� <br /> C�/flIBc�EWZq^RKr1NDSOIlA5EF000�INV�Eo���NT /NFkcY1fNE�T CONTAGTPEflSONANDPHONENO. <br /> JJ l�/ � L/ <br /> � i�CdO� /o /"�1/A� E - O,c.�S'SUl4��-1RKI 2y'2�2�3 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE� THIS <br /> PR OScD 115[OF BUII�ING �� T�. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> O f D O �'Z � �CE /��' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDE/SC—RI/Pi'IONOFPFOPER��TYr��SHCO'WN�ELOWORARACMTWOLOPIE$� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> :ot� eiocK� oF P�rbf£�ER�rT� NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �aGUN1� 3 a�PG�tTs, ��E 3Z OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR6IANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTI'10 PEFFOflM THE WORK FOR WHICH <br /> APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I D NU eEa �� �� CONTRACTORS LAW 182 RCW AND 296200 WAC. <br /> ��� Trr��/���vr p <br /> CONSTRUCt10NlOAtlLENDER A� RESS.TELEPNONE NUMBEfl � <br /> 5�� !� �/9Gf��lE�(JT "�'" � �`l! • 3-30- <br /> PRO�F�(//���QY „�IUL'. (�w� IO �}��7 sicrv�*uaE .` orrc <br /> L �Ai /� /rJec �� cirvnusmtssucrrvsrvo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> 17HT�R CLOSET(TOILET) � NC—A�HNDLG UNITS—H.P. <br /> BATHI UB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOrIY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCi!EN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER <br /> CLOTHF'i WASHER WOOD STOVE i <br /> URINFL ' METAL FIREPLACE(WOOD BURNING) ; <br /> DRINKIN�3 FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK ISERVICE—BAR,ETC.) ; ' <br /> _ � <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL 5 ' <br /> PERMIT $ � PERMIT 3 � <br /> TOTALFEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: ".J.,�,� 1 - f � ,�CUA .� <br /> FRONTSETB�GN REARSETBACK SIDESETBACK PLANC ELNNUMBER FEE REC PTNO � <br /> �� �8 . S � �� <br /> U�EZONE IOTAREA VACANT517E FEES VALUATION FEE <br /> � <br /> ❑ VES ❑ NO BUILDING � ��t� ' i � <br /> TY?EOFLOIlST. r10.OF5TORIES Occuvancr x0.arow[un�GminS i <br /> � � .' toa' � pLUMBING ' <br /> SIZEOFBLDG. FIRESPRINNlER5RE0'� B<SEMENT MECHANICAL i <br /> �2 �� Ct'j "ZYES G NO <br /> OCCUPANCYIOAD FIREAIA/P.M.REO'D HEIGHTLIA111�i1ON ADDITIONALPLANCHECK <br /> IZZ' �L'�� OTHEP / � . <br /> i <br /> RE.�SON <br /> STATE BUILDING SURCHARGE ' <br /> INiANEBY PLANSP PPFOVED�Y CITY OF EVERETT PUBLIC WORKS � <br /> �/M LOCAL SALES <br /> DATE f�j f/ �f! TAX CODE IS 3105 TOTAL 1J�- ' � <br /> � <br />