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APPLICATiC�] FOR COI�9STRUCT'�iN P�RMIT <br /> � TO BE COMPLETED IN BLACK I:IK--PI.EASE PRINT � <br /> BUILDING f" •ARTMENT HEAiING SYSTEM: CI Gi,S ❑ELECTRIC p <br /> 259•8810 <br /> �' DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ;� PLUMBING !� SIGN <br /> OWNFR IdAIL ADORESS CI7Y ZIP MONE <br /> �. �v�rewt, -�.J AL�.. �-}-/'E�^{- �'���f 9(7S� c�% S�jd- <br /> iENA�1S� ^ MAILqDDRE55 qTV ZIP PHONE C- <br /> �_1�L�J �I I�SJ�7 � �C'7 I � ( �{ T�- AJ�. S � L� ✓ `��2U� <br /> ARCHLECTO n_,,.GNER �ApILADDRESS CITY ZIP PHONE <br /> GENEFiALCONTRAC70R !!AILA�DBESS ��� ��'�`� <br /> CITV ZIP PHONE STATELICENnEp <br /> McCHANICALCONTPACTOR MAILADOBESS CIN .'IV PHONE <br /> STATE LICENSE• <br /> PLUlABINGCONTRACTOR MAILADDflESS CITV 21P PHONE <br /> SiATE LICENSE I <br /> CONTRACT PRICE OF WORK <br /> � <br /> . DESCRIOE WORH AND SOUA E FOOTAGE INVOLVED CONTAC fl D H E NO � <br /> �ov Ser�t ,�;'-� .5 <br /> � <br /> PROPOSEDI15�auuoiNe — I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��\�� APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> LEGALDESCFIPTIONOFPqOPE6TV(SMJWNBELOWORA7TACHTWOCOPIES) W RKISWILLSBEFCOMPLETED WIDTIH WHET ERvSPECNFIED EREPN OR <br /> � �a� 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 /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNtR OF THIS PRO?ERTY T PERFORM TFIE WORK FOR WHICH <br /> PARCELTAXI.D.NIIMBER APPLICATION IS MAD I COMPLY WITH THE STATE <br /> CONTRACT W 18. C� A D 296.200 WAC. <br /> CONETRUCi�ONLOANLENDER,A��RESS,TELEPHONE NUMBER ( � <br /> �P�OJEC�T� A�DD'R�ESS • 7 � .}/� s�c AiUPE —� �qtE � <br /> �[�� � 'v r CIiYBUSWE$SLICENSGNO. <br /> PLUMBING MECHANICAL <br /> � N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � WATER CLOSET(TC�LGT) � AIC—A/HNDLG 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 /> � <br /> SHOWER CLOTHES DRYERS —T— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD —T— <br /> LAUNDRY TRAY ' WATER HEATER � <br /> � <br /> CLOTHES WASHER � WOOD STOVE i <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FliiEPLACE INSERT , � <br /> FLOOR DRAIN � HEAT PUMP , <br /> BACKFLOW PREVENTERS ; GAS FIPING <br /> ROOF DRAIN£—fiAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR, ETC.) � <br /> � � <br /> — ' � <br /> � <br /> ' � <br /> SUB TOTAL $ ; SUB fOTAL $ � <br /> , PERMIT 3 � PERMIT $ ; <br /> ' TOTAL FEE $ � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACH RL\BSETBACN SIDESETBACN PLANCHECK MBEF FEE RF.CEIPTNO. <br /> .37Ulo <br /> usEzoNe �ornnr.a VACANTSITE FEES VALUATION FEE <br /> ❑ YES � 0 BUILDING �� � ' <br /> i <br /> iYPE Of CONST NO.OF STORI�S ocmrqNCr x0 0�Uw[�ui,unrts <br /> �•� PLUMBING � <br /> S2EOFBLOG. FIRESPRI LERSflEO'0 9ASEMENT MECHANICAL � <br /> � ' rj �I Q ❑ YES C NO i _ <br /> OCCUVANCV:OAD FIREALA �1RE0'D HEIGHTLIMI7ATION �1DDIilONALPLANCI{ECK � <br /> �� / i <br /> OTHER � <br /> REASON <br /> STATE P.UILDING SUFiCHARGE ����U <br /> INTAKE OV PLANSAPP OVEDBV CITY OF EVERETT pUBLIC WORKS i <br /> i L�CALSALES ' <br /> onr TAX CODE IS 3105 TOTAL ' <br />