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APPLICATiQ`' FOR CONSTRIlCTC`?IV PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECT9IC I,j <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUtLDING I_7 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER IAAILIIDORESS CITY ZIP pHONE <br /> a B r��.�{ ,�1 �e��.on. 4 c.z�� z s°c s7 fz� <br /> TENAN �lAFIL A RESS CITY ZIP PHONE / � ` <br /> � Sa� 67/6 s��vrq�,, �� ��2� � 33 7 �I�� <br /> AqCHITEC OH�ESIGNEF lAAILAODRE55 CITY T 21P PY.ONE <br /> GENEAALCONiBACiOR MAILADURE55 CITV IIP PHONE STATELICENSEA <br /> MEC'IANICALCONTRFCTOq MAILA�Of1E55 pTV ZIP PHONE STATEUCEN5EN <br /> PLUMBINGCONTRACiOR MML.IODRESS LITY ZIP PHJNE STHTEUCENSEN <br /> CONTRACT PRICE OF WORK �f ^T <br /> /� l <br /> F1 l A� . X <br /> � OESCRIBE WORK AND SOUARE FOOTAGE INVOWED ��'!�` CONTACT PEF. N AND f�r� �� ' t r�j <br /> Y <br /> � L� <br /> — � I HERE6Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED 115E OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGFLDESCRIPTIONOFPflOPERTY�SHON'NBELOWOFATTACHTWOCOPIES� WORK WILL BE COMPLETED WiTH WHETHER SPECIFIED HEREIN OR <br /> iot e�ocK oF — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEq STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNtF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLiCATION IS MADE A I COMPLY WITH THE STATE <br /> PAFCELTA%I.D.NUM9ER CQ �AW7B.Z7 Z9B.200WAC. <br /> CONSTPU.^.TION I.OAN LENDER.F��RESS,TELEPH:)NE NUMBEF � � � <br /> _ Xx 1� -� <br /> PROJE ADDRE `� Q` /�O�p sicr+erune on.e <br /> • � �V` il�V�.� CIttBU5iNE5SLICEN5EN0. .. <br /> � PL MBING MECHANICAL <br /> � NO. TYPE OF FIXTURE�JR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> . WATER CLOSET(TOILET) � AI�NHNDLG UNITS—H.P. � <br /> � BATNTUB ; FORCED AIR SYSTEMS—B,T.U. M E.A. � <br /> LA\'ATORY(WASH BASIN�� � UNIT HEATERS—B.T.U. M ; � <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ; � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN ; FIflEPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPING ; <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> . SINK(SERVICE—BAR,ETC.) ; � <br /> � I <br /> � , <br /> � ' <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> . TOTAL FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK REARSETBACK SI�ESETBACN PLANCHEC NUMBER FEE RECEIPTNO. <br /> 3 S� <br /> 115EZONE LOTAREA VAC�NTSITE FEES VALUATION FEE: <br /> ❑ YES ❑ NO T <br /> BUILDING �A �� i� <br /> IYPEOFCONST NO.OFSiORiES oCCUPANtY x0ovmvFluNGUNiiS � <br /> cAouv pLUMBING ' <br /> i <br /> SIZE OF BLDG. FIPE SPBINKLERS PEO'D OASEMENT —�— <br /> MECHANICAL � <br /> ❑ YES n No , <br /> OCCUPANCYLOAD FIREALARMPEO'D HEIGHTLIMRATION ADDITIONALPLANCHECK <br /> i <br /> OTHER � <br /> REASUN �- <br /> STATE BUILDING SURCHARGE ���D <br /> INTnN[BY p�ANSAPPROVEDBV CITY OF EVERETT PUBLIC WORKS � <br /> !GCAL SALES <br /> DATE �j I TAX C11Dt IS 3105 TOTAL � <br />