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- .4PPLICATIt�1"' FOR CONS�'F��CT'�1N PERMIT � <br /> 'f0 BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �;J ELECTRIC ❑ <br /> 259-8810 – <br /> iJ DEMOLiTION ❑ COWIBINATION ❑ BUILDING �_; MECHANICAL ❑ PLUMBING �SIGN <br /> OWNER lAAIIA�ORESS qTV ZIP PHONE <br /> TkRA/V16MrCS 2�0 /ogAu� �cFv�-e-���)[� 2oC,� y53-o3Zy <br /> TENANT MAILADORESS CITV Z� PHONE <br /> GocFar�.��s I/yoa ��4•TN Retc.Fv tP _S,�•/c, -R/ti0 <br /> MCHITECT OR�ESIGNER �f MAIL AODflESS CITY ZIP 3 PdpNE <br /> �LMIOAG'r �irGYEIVY. //32`/ /�UK/C(�U SA�Yey�7 /1jUk '�L75 bR2N TMARCFA�7 1)R <br /> GENERAICONTRACiOR IANLAOOqE55 LITV ZIP PHONE STATEUCENSEa <br /> MECHFNICALCONTRqCTOH MAILADDflESS GITV ZIP PHONE STATELICCNSEa <br /> PLl1MBING CONTR�CTOR MAIL ADORESS LIiY 21P PHONE STATE UCEIlSE p <br /> CONTHACTPRICEOFWORK �/6OO <br /> DESCRIBE WOPH AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PH�YF NO. <br /> SNSY:4Lt I S'Sr vF Cfr.4N -L t�-r 2r U�13QAL <br /> On/ �Q WA iN o FA7ME S �-rrj^O{�Z(� <br /> P+ZZa �Id R7 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PF OSED t15E OF BU iNc � qppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ' ��ZZ'Q' �E�-• PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> r ,..5 LEGALDESCRIPiIONOFPROPERTV�SHOWNBELOWORATTACHTWpCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � � ��I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ���7-. - �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING�ONSTRUCTION OR THE <br /> -- PERFORA4ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTAXI.D.NUMBER APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. � <br /> CONSTRUCTION LOAN LENDER,ADDRESS.TELEPHONE NUMBEF / /7 <br /> y �� t%CVww�, ?-i/- 9y <br /> PFiOJECT ADDRESS aioHa*"�"`''- n<re <br /> � Y cirrnu.inessi¢evservo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . _ WA.TER CLOSET(TOILET) � ,NC—AIHNDLG UNIT3—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 � CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ; WATEFHEATER � <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL � � <br /> , METAL fIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT . � <br /> FLOOR DRAIN � HEAT PUMP <br /> i <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � —� <br /> � � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL 5 � <br /> PERMIT $ � PERMIT 3 ; <br /> TOTALFEE $ ; TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSETB4CN C110ESETBACN PLANCHECK�h1B�EJR FFE /` ^, �� PECEIPTNp �Z <br /> `/ / ` � ��� <br /> USEZONE _� I.hB.'AqEA VACANTSITE FEES VALUATION FEE <br /> 96 � I� YES ❑ NO BUILDING � —' <br /> i'fPEOFCONST. NO.OFSTORIES OCCU�e�Cv qO.ovUN[LUNGUNrts � <br /> eaoua PLUMBING � <br /> i <br /> SIZEOFBLDG. FIqESPFINdIERSREO'D BFSEMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> � <br /> OCCUPANCYIDAD FIREALARMREO'D H`�EIGH�TI�IM�ITATtON ADDITIONALPLANCHECK � <br /> �KD'"U�t OTHER i <br /> REASON i <br /> STATEBUILDINGSURCHARGE � ` i <br /> INTANE BV PLANS`,PR�VLD BV CITY OF EVERETT PUBLIC WOfiKS � ' <br /> �'�� LOCAL SALES ' <br /> DATE � �9 TAX COOE IS 3105 T�TAL � ' <br /> ��G <br />