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APPLIGATI� FOR CONSTRUC'!'�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PHINT �Y� <br /> BUILDING DEPARTMENT HEATING SY�TEM: ❑GAS ❑ELECTRIC ❑ � <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �PLUMBING SIGN <br /> OWNER MFILADDRE% qTY 21P PNONE <br /> R�e! �lrsiDa,�. F.o. 'ri�v 5.��i EuE,�rt 9��c�-�;��'7 ��-s�� <br /> TEN T MAiI RDDRE55 CITV Zli PMONE <br /> �K���y� <br /> ARCHRECT OF DESIGNER MAIL ADU9E55 dTY IIP pMONE <br /> GCNERAL CANTPFCTOR MRIL qODFE55 �ITV ZIP PNONE STATE LICENSE� <br /> �k�7D.�1i, �ntT�. j�.o.�scac �a�� �✓c,�-.� �-��-i o�,�/3 <br /> MECHRNICqL LONTRACTOR M�IL RDDRESS � dTY � 21P pHONE � STATE LICENSE Y <br /> PLUMBINGCONTRACTOF MNILqDDRESS dTV ZiP PHONE STAiELICGNSEt <br /> A2T�5 p �in8/ + /C2�Cfi�.?�� S.�nf�n,�-s.4 G.rc'>U �'�f�'� �?3? Ai75��1 -/�id� <br /> GLASS OF WOqK <br /> � NEW � ADDITION ALTERATION REPAIR DEMOLITION . WOODSTOVBFRPL INSERT BUILDING FiELOCATION <br /> CONTACi PEHSON M!D PMONE NO. <br /> GONTRRCT PRICE OF W WiK .� <br /> DESCRIBE WOFK ANO SOUAFE F iAGE INYOLVED <br /> � <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAid�NED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> OF PROPERTV ISMONM BELOW OP ATTACN FWRCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � - e�ocK oF NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 1-- — �JE - OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> I PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOR�d THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WI7H THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> X <br /> raaect nnoaEss saH.n�nc nnn <br /> C�iV PU5�NF55 L�9FNSf tl0 <br /> PLUMBING MECMANICAL <br /> N0. TYPE OF fUCTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—q�HNDLG UNITS—H.P. <br /> BATHTUB ; FORCE�AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYEI75 � <br /> KITCHFN SINK& DISP ; VENiIIATIrN FAN ; <br /> DISHWASHER � RANCC HOOD �— <br /> LAUNDRY TRAV � ; W4TE!i HEAIER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE&CHIMNEV � <br /> DRINKING FOUNTAIN FIREPLACE INSE(7T ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � ! ,„ �,� <br /> � � <br /> � � <br /> I � 74 - � � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FNONTSEiBAGK IlEARSETBACK SIDESETBACK PIANC ECKNUMBER FEE RECEIPTNO <br /> � O <br /> usezorue LOiAREA YACANTSITE FEES VALUATION FEE <br /> BUILOING <br /> TYMOiCONTS.AILOWABLE TYPLOfCONST.AAUAL a[cUo��r NoapnluNtuNrtS � <br /> �"WP - PLUM9ING i <br /> SRE OF BLD(3. NOAF STOFIES B,15EMENT MECHANIGAL � <br /> i <br /> OGCIIPANCYLORD FIRESPRNKLEflSREOD MEIGMTLIMRRTION A�QITIONALPLANCHECK i <br /> i <br /> SPPINKLER ' <br /> REASON fOR SPRINKLERS -� <br /> ' STATE BUI�DINCo SURCHARGE i <br /> MTr1NE BY PLANS APPROVED BV CITY OF EVERETT PUBIIC WORKS � <br /> LOCAL SALES <br /> TAX COUEIS 3105 rora� <br />