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APRLI�ATIQ"� FOR CONSTRUCT"lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BI;ILDING DEPARTMENT �1EATING SYSTEM: ' GAS ']ELECTRIC ❑___ <br /> 259-8810 <br /> ❑ DEMOLITION i_i COMBINATION ! J BUILDING �MECHANICAL PLUMBING Ci SIGN <br /> � <br /> R MAIL RD�RE55 GITY �IIP PHONE <br /> �c� c� -NA�\�v� v 13�. �'A\b�! ��� e ���Ol ��'1 ' Jv 1 I _ <br /> TENAM ^ ^ 41AIL AD�RESS CIiV IiP PMONE <br /> \ \ 1 1 \ <br /> ARCHRELTORDESGNE9 MAILADDRE55 GITV 21P PHCNE <br /> 1'1 1 �� <br /> GENERAL GONTRRGTOR MAII AD7RE55 CITY ZIP PHONE STATE LICENSE� <br /> � 1 � <br /> MFLMAN1L�l GON,TR`A\CTOF MAIL ADDBE55 GITY 21P PHONE SiqTE LICENSE P <br /> �.W•� <br /> VWMBINGCONTqACTOR MAILAD�RESS GITV ZIP PNONE STATELICENSEt <br /> CA�i P��F_.W'�.� <br /> ./ <br /> DESCFIEE WORN�ND 5011APE FOOTAGE INVOIVED LONT�CT PEflSON AND P/ANE NO <br /> �\'1S�G�\��G �� � rl <br /> � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFC2 ALL <br /> PROVISIONS OF LAWS AND ORDINANCE�GOVERNING THIS IYPE OF <br /> LEGALDESCRIPTIO40FPPOPERTY�SHOWN6ELOWORATTACHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEGFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT eiocK oF AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AN� I COMPLV WITH THE STATE <br /> PARCEL TA%10.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 W C. <br /> CONSTRUGTIONLOANLENDER.ADDPESS,tELEPMONENUMBER ( (/ �Jn� �J�l' '/� � S �� <br /> X /-1 /7 <br /> �i� <br /> PR RESS \� � � � s�cN.n ac o c— <br /> cnv pusm�ss uurvse ra <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE Of EOUIPMENT fEE <br /> WATEF CLOSET(TOILET) A/C—AIHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS � _ <br /> KITCHEN SINK&DISP VENTILATION FAN ' <br /> DISNWASHER RANGE HOOD <br /> --� <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTEFS I CAS PIPING I <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) I <br /> � <br /> SUBTOTAL $ SUBTOTAL $ ' <br /> PERMIT $ PERMIT $ <br /> TOiAL FEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAN LNECK NUMOER FEE RECEIPT NO. <br /> ''� "Z <br /> USE ZONE LOT AREA VACANT SITE F F$ VALUATION FEE <br /> Ll YES ❑ NO BUILDING <br /> iYPEOFCONST NO.OFSTOHIES acurr,Na Nawmv[umcuNrts — � <br /> unaur PLUMBING � <br /> �i— <br /> � <br /> SIZE OF BIDG. FIRE SPRINKLERS REO'0 AASEMFNT MECHANICAL <br /> i7 VES i 7 NO � <br /> OCCUPRNfVLOAO FIRE�LARMREQ'D HEIGNiLIMITATION ADOITIONALPLANCHECH i <br /> OTHER <br /> REASON <br /> S7ATE�UILDING SURCHARGE <br /> INiAKE 0Y %ANSAPPROVEO BY CITY OF EVERETT PUBLIC WORK$ � <br /> LOCAL SALES , <br /> DPTE TAX CODE IS 3105 TOTAL <br />