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APPLICATIQ�! FOR CONSTRUCT'"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC CJ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION f� COMBINATION s,;:{�• f�,BUILDiN��;�,:9 fjMECHANICA4 , ; .;�)p;PLUM8ING �_7 SIGN <br /> OWNEfi MAILAODRE55 CITY ZIP FHONE <br /> /NC,-M i�7 �ZL? I ff�,t���1e. �. �F.ilPUur. �I�Lt�f <br /> T��ICI.���I"/�l"IIII����lAAILAIIE/AClI' Yl^..'!LW/ I C'�eC.. ZIP PHONE <br /> ARCHITECTOR�ESIGNER y MAI� E55 CITV ZIP PHONE - .�, „ `; <br /> G/��IAU itt�GSl l.l.����(l�ryL 1Y�Ru'1��' � L �N "/)�� '����� I� PHONE �,1��J /T/ /�/CENSE 1 / I ��LL1_S1 <br /> n I f 1 1 T^ I / ��/� ,.y�f ' <br /> 4 7 <br /> MECHANICAI CONTRACTOR MAII AODPE55 GITV ZIP PHONE T�TE IICENS'c a <br /> PLUMBING CONTRACTOR AIAIL ADOFE55 CITV ZIP PHONE STATE LICf�NSE• � � .... .. <br /> CO"ITFACT PRICE OF WORN g,j�� /� � � � - � � <br /> 1 I L� i n� �. . . �, ' <br /> DESCRIBE WORK AND SOURRE FOOTAGE INVOWED �/ '_ � CONTACT P:RSON�N�PHONE NOn I . /. r ��� <br /> A • � l, l <br /> �(�tU� TttFki: !F;�1�l�1' � ' , <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOF9UILDING `��. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECt ALL <br /> 2 Jl' PROVISIONS OF LAWS AND ORDINANCyES GOVERNII!G,THIS TVPE OF <br /> LEGALUESCHIPT;ONOFPPOPERiV�SHOWNBELOWORATTACHTWOCOPIES�� � � � � WOFK WILL BE COMPLETED WITN WHCTHER SPECI=1[D HEREIN OR <br /> �oT BLOCK oF � ' NOT..THE GRANTING�OF.A PERMIT�D,Q€S;NOT�PRESUME.TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE-PROVISIONS OF ANY <br /> 5�: ��-�C�.�n, ��, . � � �. OTHER STATE OR LOCAI:LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF COP'STRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY�TO�PERFORM�7HEWORF�'FOR�WHICH <br /> . APPLICATION IS MApE, ANQ I COMPLY WITH .THE iSTATE <br /> PARCELTA%I.D.NUMBER , ' � CONTRACTORSLAWIB.Z7RCW�AND2%.200WAC.� '- ' <br /> CONSTRUCTION LOAN IENDEfl.ADDPESS,TEIE�HONE NUMOER I � a///� y' / <br /> � PROJECT DDHESS j . . , X��( /G��C/L:�U.C�(. ��'LZ.G� l <br /> � ;SMjN�NE i:�I'... . D�IE <br /> � �' ��� ��r� LIiVpU51NE$SIILEN$LNO <br /> �<. <br /> � PLUMBING - MECMAMCAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE N0:r� •��'�� TYPE OF EUUIPMENT FEE <br /> , WATER CLOSET(TOILET) � PJC—A/HNDLG UNITS—H.P. <br /> 6ATHTUB � � '';� � ' ' " 'FOFiCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> � <br /> SHOWER ' CLOTHES DAYERS ! <br /> KITCHEN SINK 8 DISP � �' ' ' �� �� ` � � � ��VENTILATION FAN ; <br /> DISHWASHER - � � � � RANGE HOOD <br /> � LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � � `NOr3D STOVE � <br /> URINAL - - ; . � �M TpL,FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> F�OOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ..;, , . GAS P�PING ; <br /> ROOF ORAINS—RAINLEADERS , -� �� ' ' �EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � � <br /> � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL 5 ; <br /> PERMIT $ � PERMIT 5 <br /> TOTALFEE S ; TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FqONT SETBACK RERq SETBAGK SIDE SETBACK PLAN CHECN NUMBER FEE RECEIPT NO. <br /> , D <br /> USEZONE LOTAREA VACANTSITE FEES VAI.UATION fEE <br /> '�.J YES �_.I NO BUILDING 2�Z J 2�/—! <br /> TVPFOFCONSi. NO.OFSTORIES IX[uvavn NOamvElmmmnrs — <br /> / °q1 PLUMBING ; <br /> � �_ <br /> SIZE OF BLDG. FIRE$PRINNLEFS REO'0 BASE6IEYT MECHANICAL ' <br /> 2 $6 o r.i. ���5 ❑ YES / � — <br /> OCCUPANCYLOAO FIREAIARMFE00 HEIGHTLIMITATION ADDITIONALPLANCHECK i _ <br /> i <br /> � �O OTHER ' <br /> REASON � <br /> ��(,f j�� � STATE BUILDING SURCHARGE � <br /> INTAHE BV PLANS APP VED�Y CITY OF EVERETT PUBLIC WORKS — <br /> � � LOCALSALES <br /> DATL � 3O�S y TAX CODE IS 3105 TOTAL 2 Z ��U <br />