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pppLICATIC�1 FOR CONSTRUCT�N PERMIT ��� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � ���ATING SYSTEM� J GAS 'J ELECTRIC ❑ _ <br /> BUILDING DEPARTMENT <br /> 259-8810 -,MECHANICAL !,•PLUiNBING =. SIGN <br /> �' DEMOLITION f_; COMBINATION ❑ BUILDING PHo� <br /> � q MAII ADORE55 GTY �� ZIP� /J�'J �J � - ��� <br /> 7a S ��� ° <br /> ����( � �� � GTY ZIP PHONE <br /> TENN+T �L ADDRE55 <br /> nRCNRECTORDES�GNEF MAIIADORE55 <br /> qTY 2�P PHONE <br /> GE�� LGONTRALTOR MAILAODRE55 <br /> CITY ZIP PNONE S7ATEUCENSEs � <br /> J Cliv ZIP PHONE STAIFLICENSE� <br /> MECH4NILALGOPoTFACTOP MAILADDRE55 _ <br /> �m, Z�p PNONE STAiELICENSEM <br /> FLUMBINGCONTFAGT�R MA�LPDD(iESi <br /> COHTRRGTFFif�P�[C J�� —�. <br /> DESLFIBE WORK p�'1�SW ARE FOOIAGE INVOIVED <br /> LONTACT PERS[Y�.UdD PNONE NO. <br /> �;n X �U � <br /> 1 HEFEBY C"tFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF 8 LDIy�- / APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S Ft�-- �/�'��G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGFLUESCRIPTIONOPPROPERTVISNOWNBELOWOBATTACNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PflESUME TO GIVE <br /> ioT B�aK oF AUTHORITV 70 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCiION OR TNE <br /> OWNEOR OFNTNISOP OPERTY TO PER nRM HE INORKIFORBNHICH <br /> APPLICA710N IS MADE AND I COMPLY WITH THE STATE <br /> vnRce���x i o nurnaea CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 'i�� =���� �r�=' �_a`� " <br /> GON5TRULTIONIOANL[NJER.ADDRES5.iELEPNONENUMBER / ; J y ' ! �, <br /> X—_ j o`+�[ <br /> � snrw��� � <br /> PqOJECT ADDRESS ���S c++eus,wc rc�ese No <br /> MECHANICAL <br /> PLUMBING FEE NO. TYPE OF EDUIPMENT FEE <br /> qQ, TYPE OF FIXTUPF OR ITEM ,qi�A HNDLCd UIJIT3—rIP. — <br /> WATER CLOSET�TOILL i 1 , FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB � UNITHEATERS—B.TU. M ' <br /> LAVATORY(WASH BASIN) �— <br /> CLOTHES DRYERS —�-- <br /> j SHOWER . � VENTILATION FAN � -- <br /> I KITCHEN SINK 8 DISP <br /> � DISHWASHER � RANGE HOOD ��-- <br /> � LAUNDRYTFAV � WATER HEATER <br /> WOOD STOVF � <br /> I CLOTHES WASHER , METAL FIREPLACE(WO�D BURNING) '� <br /> URINAI FIREPIACE IIJSERT ' <br /> DRINKING FOUNTAIN HEAT PUMP � <br /> FLOOFl DRAIN GAS PIPING ' <br /> BACKFIOVlPREVENTERS � EXHAUSTFAN � <br /> ROOF DRAINS—RAINLEADERS � ' <br /> SINK(SEFlVICE—BAR,ETG,) � � <br /> �— <br /> � , <br /> — � , - <br /> � �'� <br /> SUBTOTAL S � <br /> SUB TOTAL $ i — pEp��11T � '— <br /> PERMIT $ ' T07AL FEE $ <br /> TOTALFEE $ ' <br /> FOR nFFICE USE ONLY: �-- <br /> FCE RLLEIPT O <br /> f�[F 5[�BACN SIDESETBAGN --- `I PtA!IGN[GNNUMBER �D, �� ,, �L.���//' <br /> FRONT SETBAGK � J. \ /�O� Y" <br /> '� 7i../'� i �,...'1i� L__,�jLi .�,, '�.(-.:� Y..1' ( � FEE <br /> � �� FEES VALUATION <br /> LOT AREA VACANT SITE /n �� <br /> ❑SE ZONE i — <br /> , • : , ❑ VES ❑ NO 6UILDIN— G 3�j - �—L"---- <br /> � <br /> �� NO.OF STORIES ar.uvexcv u0�PMuiu6uNin ._1_ <br /> irP[OtCON57. caouv pWMBING �--i— <br /> I _ J FlRE SP�AE�'� BASEMENr MECHANICAI T_ <br /> s¢e oF etoo � YES n NO <br /> 2?,O 5f D�c. � I <br /> ADDITIONAL PI AN GHECK T <br /> � OCCUPANCY LOFO PIRE ALARM fiEO'0 HEIGMT LIMITATION � i <br /> 1 �' <br /> IA f'� OTHER _ _ � <br /> R=ASON STATE BUIL��NG SURCHARGF' <br /> L "� <br /> _ i <br /> — y <br /> INTAKE BY PLANSAPPROVE00V ��N OF EVERETT PUBLIC WORK$ <br /> ,_,►}� �oca�saiEs � � <br /> / TAX CODE IS 3705 TOTAL � <br /> onre,q. �J/�j3 <br />