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APPLICATIC""� FQR CONSTRUCT'lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC J <br /> 259-8810 <br /> !7 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER/J ,/ IA�AODRESS CIN 21P PNONE <br /> ( �.� h� fa� �a� �7C //o �,�� q�iaS 3 �.5 /a3v <br /> �?ENAMT AILA��RESS CITV Zlp PHONE <br /> -- /�d�'p�"�-� <br /> ARCHITECTOR�FSIGNEfl MAILAD�RESS CITY ZIP PHONE <br /> GENEflALC iR:.CTOR MNIAJDRE55 CITV IIP PHONE STATELICENSEu <br /> ' � " <br /> MECHANICAL CONTRACTOR MAIL q00RE5S QTY 21P PHONE STATE UCENSE u <br /> '�.0 /L <br /> PLUMBINGCONTRACTOR MAILADDRE55 CIN ZIP PHONE STATELICENSEa <br /> '.�, � � <br /> � q - CONTRACTPRICEOFWORN <br /> p 1 ,". <br /> �1 __ _ <br /> �� -� � �' OESCRIBE WORK AND SOUAPE FOOTAGE INVOLVED CONTACT PERSON AND PHONE N0. <br /> �//(—�_'' !^C'�' _ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PflOPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGAL0E5CRIPTIONOFPROPERTY�SHOWNBELOW'niATTACHTYJOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or 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 /> OTHEfl STATC OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> PARCELTA%I.O.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> WNSTRUCTION LOAN LENDER.ADDRE55,TELEPHONE NUMBER � q� /� <br /> PpOJECTADDRESS � r+AT�A��`v' l�' �4��Vore <br /> O — �R C�IZ l L�'� W q � S U� � urv eusiNess uceHse Ho. � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM �EE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A!C—AIHNDLG 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 /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT . ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � ct � � Je � I <br /> � � � <br /> ca1-,. A-i) >�r.ti L. i ' <br /> i <br /> � n, � � <br /> � SUB TOTAL $ '�- ; SUB TOTAL S /, — <br /> PERMIT 5 ��Ij PERMIT $ � <br /> TOTAL FEE $ � / ; TOTAL FEE 3 /' � — <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAflSETBACK SIDESETBACK PLANCHECHNUMBER FEE RECEIPTNO. <br /> �/�S� <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> G YES ❑ id0 gUILDING i <br /> TYPEOFC@15T NO.OFSTpqIES O[CuoaNcv uOAFOwEumGUruiS � <br /> anour PLUMBING ; — <br /> SI/E OF BL�G. FIRE SPFlINKLLRS REO'D BASEMENT MECHANICAL � � <br /> ❑ YES ❑ NO <br /> OCCl1PANCVLOAU FIREALAFMREO'D HEIGNTLIMITATION p.DDITIONALPLANCHECK i <br /> i <br /> OTHER ' <br /> . REASON � <br /> STATE BUILDING Sl1RCHARGE i <br /> INTAKE BY PIANSAPPROVED BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> DATE TAX COUE IS 3105 TaTA� �-[r; dv <br />