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�'P;P'PLIC�►TIC�9 FOR CON�T�i � <br /> - TO BE COMPLETED IN BLACK INK—pLEASE FRINT <br /> �EATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBiNATIQN ❑ BUILDING ❑MECHANICAL ❑ PLUiiABING 'IiSIGN <br /> OWNER M4ILADDRE55 CITV ZIP PHONE 1 /3 � ���✓ <br /> C C�� S.ti i-R � �Je✓e'fY �G�3 ��z _ �s>_a-c <br /> nn 4 •� .1 L�✓ercYPPr� <br /> TENF T _ , ., MAIL p�9pRE5S 1 U \. r CITV � 11P . PHONE <br /> �r'—i{'-�j��7rPf7'TrTiZZ� , >'A1���(� ' <br /> � � ��Ty Z�p PHONE <br /> ARCHITECTOflUESIGNER MAILAD�RF.SS <br /> Crnc < c.�i� � 7Y/3 n.� i�".t sf �7�zj,,•� 97u�6 �-3� -87� <br /> GENERALCONTRACTOP AIAI�AUDRE55 CITY ZIP PHONE STATELICENSEN <br /> 7 (1,.wrc.Hc� Sc7/ ? S Gil S� �iFti . Sec��tl.a ��'/3� S61-�8� T 1 7/-IN .�o_'z�ck <br /> � MECHANI ALWNTAACTPR MAILAOOFESS CIN 21P PHONE STAiELICENSEp <br /> , . I` . _ Y <br /> PLUM NG NTPACTOR MAIL ADORE55 CITV ZIP PHONE STATE LICENSE R <br /> CONTRACT PRICE OF WOFN <br /> D 'l <br /> DESCRIBE WOflK AND SOUARE FOOTAGE INJOWE7 CONTVCT PEPSON�ND PNONE NO. <br /> D �o t• y-�_ o•x 9 , _ U., , <br /> � a�c Gt o � �-3 {- �Y�� - <br /> I HEREBY ;'ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aq OSED USE OF8UILDING 1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PS . n � !�s �� 1 PROVISIONS OF LAWS AND OR6INANCES GOVERNING THIS TYPE OF <br /> LEGALOESCflIPiIONOFPRCPERN�SNOWNBELOWORATTACHiWOCOPIES) NOT THELGRA T�ING OF AD ERMIT'DOES NOT PRIESIME TO GIOVE <br /> �o' B�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CGNSTRUCTION OR THE <br /> - � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEA OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAl'ION IS MADE AND I COMPLY WITH THE STATE <br /> PAPCEL TAR I D.NUMBER CCMTRAL'TGRS LAW 1827 RCW AND 296200 WAC. <br /> 1 _ ;, Z - c� r - 00�6 <br /> CONSTRUGTION LOAN LENDER,ADDRE53,TELEPHO�r=WUMBER <br /> / �z� C�-- Gc�N ��/ /�� <br /> ' SiGrvnrunE onL <br /> PHOJECT ADDRESS . <br /> �v CITY BUS W E55 UCENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IYEM FEE N0. TYPE OF E�UIPMENT FEE <br /> - WATER CLOSET(TOILET) � � NC–A�HNDLG UNITS–H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS–B.T.U. M E.A. ' <br /> � <br /> LAVATt1RY(WASH BASIN) � UNIT HEATERS–B.T.U. PA � <br /> SHOWER ' CLOTHES DRYERS —T— <br /> KlTCHEN SINK 8 DI$° � VENTILATION FAN �_ <br /> i <br /> DISHWASHEFi � _ RANGE HOOD — <br /> LAUND9Y TFlAI' ; WATER HEATER <br /> CLOTHES WASHER i WOOD STOVE ' <br /> � METAL FIRFPLACE(WOOD BURNING) ' � <br /> URINAL � � <br /> DF!NKING FOUNTA�N I FIREPLACE INSERT �_ <br /> FL07R DRAIN � HEAT PUMP ' <br /> ' GAS PIPING <br /> BACI(FLQW PREVENTERS � <br /> ROOF DRAINS–RAINLEADERS � EXHAUST FAN <br /> SIN�((SERVICE–BAR,ETC.) � � <br /> � — <br /> � <br /> � <br /> � �– <br /> � � <br /> SUB TOTAL $ ; SU8 TOTAL 5 � _ <br /> PERMIT S � PEflMIT $ �_ <br /> i TOTALFEE $ ' <br /> TOTALFEE $ � <br /> FOR OFFICE USE ONLY: _ REc iPT <br /> PLANCHECK�IIMBER FEE � �7'= �pP'� ,f <br /> FRONT SETBACK� REAR SETBACN SIOE SEOA�N � c z �� <br /> i ,a.;�� � � � � J -I <br /> !'-"�} -- VALUATIOi: FEE <br /> USE 20NE :'OY AREA VACANT SITF, FEES � ' ' <br /> � � 3L� ❑ veS ❑ No BUILDIMG _OSO r � ' O�� <br /> No.oF57oR1@S occuvxxtv �xoerUWnlu�auxiis ' <br /> TVPEOFLONST. cnou> PLUMBING ' <br /> T <br /> 1 <br /> SRE OF BIpG. FIPE SPRINKLER$REO'0 BASEMENT MECHRNICAL � <br /> ❑ YES ❑ NO � <br /> ADDITIONAL PLAN CHECI( ' <br /> OCCUPANCV LOAO FIRE ALAHM REO'O HEIGMT LIMITATION i <br /> � �%''�" %C�K OTHER � . <br /> 7.5 _ —� <br /> , <br /> REASON STATE BUILDING SURCHARGE � ' ' <br /> i <br /> INTANE BY PLiN�'A�6VE0 BY ��7y OF EVERETT P�BLIC WORKS — � <br /> � � � TAXCODE SL3105 TOTA� �,�/ " �' <br /> na-� �v ,� 3—r�( _. <br />