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APPLICATIC'4 FOR CONSTRUCT''�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> [3UILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-BB10 � <br /> ❑ DEMOLITION Li COMBINATION ❑ BUILDING ❑MECNANICAL �PLUMBING Ir�SIGN <br /> ✓O ER MAILqD�0ES5 ITV ZIP PNOI <br /> �l�,u�t �11arip.nfi� .5ko-�aQ G'D • l�ox Sa�,7 C-V�r�tfu.�-• ��ao� -5267 <br /> ��, NRNT M�IL AODRESS CITV 21V PNONE <br /> � onna .e rri�v ��S Cvf 6i�- Lfue 4o�n�F' Zc� � �r�aol <br /> ARCNITECiORDESIGNER MAILAODRE55 CITV 21P PNONE <br /> �GENEFAL ,ONT ON MA ADDRESS ZIP PNONE STATELICENSEs <br /> �'��� �e��r ra r�rk.5 S�a n J�PS i�i� �'`3/� /��"fi'p/ �(1 <br /> MECH/.NICPL CONTRFC70R MpIL�ODRES$ � TV ZIP PHONE SiRTE LICENSE• <br /> /,�Iir��l��,7 ��'� 7� lr..�%� �=sr� �s'9/i/.f' <br /> PWMBINGCONTRACTOR MAILADOPE55 CITV ZIP PHONE STAiELI�ENSE• <br /> CONTRALT iR/I'�CE OF WOR/K�'] � <br /> � V ! CSd�—'� <br /> DESC IBE,'�'Ofi�ND SOUARE F AG[ VOL D p .CONTA PSON AND PNON\ <br /> °�i �rrs a4 . ' h. c s-� 7 <br /> 5. " Lo� - <br /> i HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br /> PROPoSEDUSEOFBUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SNOWNBELOWOA�TTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANtING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT eiocK oc AUTHORITY TO VIOLATE OA CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLV WITH THE STATE <br /> PPPLEL TA%I 0.NUMBER CONTRACTORS LAW 18.27 RC W AND 296200 WAC. <br /> CONSTRUCTION IOAN LENDER.ADORESS,TFLEPNONE NUMBER n <br /> PROJECTADDRESS X ��`'�'r����,%r 2 %D�S J� <br /> ' �� C�llu U,Uc.. �cu�.e-f� s��.,�a< <, o�iE <br /> � CIiY9V5Mf55UCEN5[1q <br /> PLUMBING MECHANiCAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEA CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER T WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUflNING) <br /> DRINKING FOUNtAIN i FIREPLACE INSERT i <br /> _ —� <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEA�ERS � EKHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) ' <br /> . , <br /> � � <br /> � ; <br /> � � <br /> SUd TOTAL 5 SUB TOTAL 5 ; <br /> PERMIT 5 � PERMIT $ <br /> TOTAL FEE 5 ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONT SETBACK RERR SETBACH SI�E 5[iBAGK PLAN CHECK NUMBER FEE RECEIPT N <br /> _,, � ' , 9� O�CcO�� <br /> use zoNe wr nnea � vncnrvi sire FEES VALUATION FEE <br /> i,i YES ❑ NO BUiLDiNG � �" <br /> 7YPC Uf CONST NO.OF STORIES occvr�vh uo m bxauxcuxi�s � <br /> cnuua p�UMBING i <br /> SIZEOPBLDG. FlRESPPINKLERSREO'0 3ASEMENT MECHANICAL � <br /> ❑ YES ❑ NO <br /> OCCUPANGv LOnO FlRE ALARM RE00 HEIGNT LIMITATION ADDITIONAL PLAN CHECK <br /> �v'_�_� OTHER ' <br /> � <br /> il[RSON � <br /> STATE BUILDING SURCHARGE <br /> INIf.HG OV PUNSAPPROVE��Y CITY OF EVERETT PU�LIC WOflKS ' <br /> JM LOCAL SALES � <br /> „AT� 'r�i�/�'� TAX COOE IS 3105 70TA1 � 7 h�� <br />