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APPLICATIQ'� FOR CONSTRUCTt�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING UEPARTMENT HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ -� <br /> 259-8810 <br /> L DEMOLITION ❑ COMBINATION'�,,;. ❑ BUILUING . OMECHANICAL �PLUMBING CI SIGN <br /> pOWNER MAILADDRESS CITV ZIP PHONE <br /> I�AViS{�d/Yl �.D �JC ZZZ7 �verP� ��Z03 ZSZ'"Ol�-? <br /> TENANT MAILA��RESS CITY ZIP PHONE <br /> APC�r��,� (ahn,� fidn (n� �*''t- sa^ti`�- <br /> JESIGN[R A1� CIN 21P PHONE . � , <br /> GENEFALCONTRACTOR MAILADDRESS CITY ZIP PHONE � � STATELICENSES � <br /> MECHANICALCONTRACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEu <br /> PLUMBINGCONTRACTOR MAILADDRESS � CITY ZIP PHONE STqTELICENSEa � i� . <br /> �P�l — <br /> ONTRACTT PFICE OF WORH � <br /> V <br /> OESCRIBEW PHANDSOUA OOTAGEINVOLVEO CONTACT E SOIy�N PHONENO. <br /> „ • c d � r ' �� �d <br /> d•( r c� � <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAD�IINED THIS <br /> PROPO ED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES.GOVGRNING THIS TYPG OF <br /> �ecn�oesceipnoNOFaRoeeRrv�seowNeaowoaanncHnvocories7' � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED�HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME.TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION-0R THE . <br /> - PERFOFMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE'WORK'FCR WHICH <br /> , APPLICATION IS MADE, AND ,I COfdPLY WITH THE STATE <br /> anace�rnx i.o.r+uMeea � CONTRACTORS LAW 1827 RCW AND 296.200 WAC. ' � <br /> CONSTRUCTION LOAN LENDER,ADDRESS.TELEPHONE NUMBER X / i�'�/ / � � <br /> :l./�ii /�' "�� �/ <br /> %i�(/ / O <br /> PROJECTADDRESS . , , ��s�� • E . ' on*e <br /> i OZ CITYBUSYESSLICENSENO. <br /> ' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO.�� - TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB - ' � - FOflCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP �� -�' � � � � ' VENTIIJ+510N FAN � <br /> . DISHWASHER .� .�. � RANGEHOOD � <br /> � ' WATER HEATER ' <br /> LAUNDRYTR�.Y <br /> � CLOTHES WASHER � -WO�ODSTOVE � <br /> URINAL � .,.i-� �,� ' �METAL FIREPLACE(WOOD BURNING) ' <br /> DFINKING FOUNTAIN �� FIREPLACE INSERT � <br /> I FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAIN�RAINLEADERS - ' � � � � EXHAUST FAN � <br /> � ( SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> , � <br /> — �— <br /> I <br /> SUB TOTAL S ' � SUB TOTAL 5 ; <br /> PERMIT 3 ,7O � ' PERMIT $ � <br /> TOTAL FEE $ '� TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBALK REARSETBACN SIDESET9ACK PLANCHE KNII Efl FEE RECEIPTNO. <br /> S � <br /> usezoNe LOIAREA vncnNisrte FEES � VALUATION FEE <br /> ❑ YES C� NO BUILDING � <br /> 7VPEOFCONST. NO.OPSTORIES a[uraxcr x00rCx[luxGmua i <br /> enour pLUMBING i <br /> SIZE OF BL�G. FIFE SPRINKLERS FEO'D BASEIAENT MECHANICAL � <br /> [1 YES ❑ NO — <br /> OLCUPANCVLOAO FIREAIARMREO'U HEIGHiLiMITATION AODITIONALPLANCHECK i <br /> OTHER <br /> PEASON <br /> STATE BUILDING SURCHARGE <br /> INTANE BY PLANS APPROVE�BY CITY OF EVERETT I�UBLIC WOANS � <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 T�TA� ; <br />