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APPLICATIO'~ FOR CONSTRIJCT[ � N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �1 GAS ❑ELECTRIC ❑ <br /> � <br /> 259-8810 <br /> '�(DEMOLITION ❑ COMBINATION 1=1 BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEP MAIL�DDRESS pTY ZIP PHCNE <br /> M6MAH 3zo �ogT" n� +sfoa 'g�,14.v�. wa q8004 �53-o3Z4 <br /> TENANT MAILPO�flE55 CITY 211' PHONE <br /> ���� <br /> ARCHITECTORDESIGNER MAILADOflE55 qN 21P PHONE <br /> noxf�. �Sc o1R Ak�r�4 <br /> GENEflALCONiRACTOR MAILADDRE55 CiTV ZIP PHONE STATELICENgE� <br /> SDL 'RaBco� I(.BT� �Re1L►VW! WA 98oc13 6�-4-35!(� SDLGo��1c 2��.9Q <br /> MECHANICALCONiRACTOfl MAILADDRESS CITV ZIP P410NE STATELICENSEI <br /> r�orv� <br /> PLl1MBINGCONTRACTOR MAILAODRE55 CITv ZIP PHONE 57ATELICENSE/ <br /> *�Kx.. <br /> CONTRACT PRICE OF WORK <br /> f2, 4ocs'� <br /> DESCRIBE WORK�ND SOUAPE FOOTAGE INVOLVEU CONi�CT PEf150N AND PHONE NU. L �F�'► �'--'�/�Z <br /> Jirrto��S�n. V �vl�cl\ a* <br /> C�O�rirO� il11 � N �� t HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIL�ING APPL�CATION AND KNOW THE SAMF.TO BE TRUE AND CORRECT.ALL <br /> �_�1_ ���� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALD'cSCRIPTi!)t'OFPROPEflTY�SHOWNBELOWORATTRCH7WOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT — BLOCN oF AUTHORITY TO VIOLATE OR CAIJCEL THE PROVISIONS O� ANY <br /> �L ��,� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEfiFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEflFOFM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBEfl �S�Q _�O_ OOI — Q QQ9 CONTRACTORS LAW 1827 RCW AND 296.200 VJAC. . <br /> _r <br /> CONSTflUCTIONLOFNLENDER.A0DNE5S,TELEPNONENIIIABER /� /���� <br /> Se.a��rsfi E�+rt. VEl-7oN 35$-351 R X G <br /> PROJECTADDRESS �/A�r ��� ¢� ,_l s�cH�tune o�ie <br /> �'%� J W CIlYBU5ME55UCEN5EN0. <br /> PLUMBINr, MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLC;UNITS—H.P. � ' <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U: M E.A. ' <br /> �. LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M 1 <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN S�NK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' _ <br /> DRINKINC,FOUNTAIN � FIREPLACE INSERT � � <br /> FLQOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ! <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � � <br /> , i <br /> , i <br /> � � <br /> � i <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> FERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAfl5ET6ACK SIUESET6ACK . PLANCHECKNUMB� FEE PECEIPiNO. <br /> a�s <br /> USEZONE �OTAREA �ACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO ' <br /> BUILDIN!';� � <br /> lYPEOFCONSI. NO.OFSTORIES acurANGr IlowUwtlllucuxlts i <br /> enour PWMBING i <br /> 52E OF BLOG. FIRE SPRINNLERS REO'0 ��SEMENT � <br /> MECHANICAI ' <br /> ❑ YES ❑ NO i <br /> OCCUPANCY LOAD FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> � <br /> ! <br /> OTHER i <br /> —�— <br /> REASOIv i <br /> � STATE OUIL�ING SURI:HARGE � <br /> � <br /> INTANEBY PLAN$l�PPROVEOBV CITY OF EVERETT PUBLIC WORK$ i <br /> LOCALSALES , <br /> ,,,,,E TAX C�DE 3S 3105 TOTAL � <br />