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- APPLICATION FOF� CONST�UCTiON PERiVI1T /;✓� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �,ELECTR�C f] _ —� <br /> 259-8810 � <br /> ❑ DEMOLITION ❑ COMBINATION x BUILDING f:l MECHANICAL i=J PLUMBING ❑ SIGN <br /> OWNER '1 � � MAILApODRE55 .I '• CITV ZIP PHONE fF �/ <br /> 5��•l.��a�—,I��OL/� ��3 /IH/ �t?� ]Ofl(r%I�k.'1Z�S(fT�q�s ir�' A�n s� L1r� ,7�_ �r <br /> 7ENANT IAAILA�UNESS C17Y ZIP PHONE <br /> ..�iFcSGE/�k��#�=LL�n NE 33��. �3ca� ;�'�, [��-- �aY� 8��-- <br /> ARCHIIECTORDESIGNER MAIL/DDFESS CIN 21P � PHONE <br /> �/�d�2Tlr4�l� ti�a�/48tc <br /> G E N E R A L C O N T R A C T O R MAILA�OflESS �ITV ZIP pHONE STFTELICEIlSEM <br /> �sr/.McD2. ��/e� �f�oS 1� /(!�T•�`7/yl �2KCA�,�.D L</A- �,�c f $a�l-7.��1 <br /> AtECHANICALCONTRACTOR MAILADDRE55 CITV ZIP fHONE STATELICEKSEM <br /> PI.UMBINGCONTRACTOR MAIIADDRESS CITV ZIP PHONE STATELICENSEs <br /> CONTRACT I'RICE OF WOi1K <br /> /0 7SU• ..+.+ <br /> DESCRIBE WORK AN SOUAR OOTAGE INVOLVED CO TACT PER50 AN ONE NO. <br /> � t� <br /> N <br /> I HEREBY CERT�FY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �>CC— PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEFTY�SNOWNBELOWORATTACHTVJUCOPIES� WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING C0�'STRUCTIOM OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA% O.NUMBER APPLICATION IS MADE AND I CUMPLY WITH THE STATE <br /> �=30 CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS,TELEPHONE NUMBER � <br /> —L' /� 3 _ <br /> PpOJECT ADD ��Ss/e / � sir e .e <br /> /�/3'I �YG�'/'If���l.1 Us�/, .���� �n rtreus:N �ceHseHo <br /> PLUMBING T CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE .. . =��Ih! <br /> WATEfl CLOSET(TOILET) A/C—A/HNDLG 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 ; VENTILATION FAN <br /> DISHWASHEfl � RANGE HOOD <br /> LAUNDRYTRAY ; WATERHEATER ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN ; FIREPLACE INSERT . ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADEFS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.; ; ' <br /> � <br /> — ' —:— <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL $ ; <br /> PERMIT $ PERtvIIT $ � <br /> TOTALFEE $ ; TOTAL�EE $ ' <br /> FOR OFFICE USE ONLY: <br /> FFONTSETBFCK REARSETBACK SIOESETBALK PLANCMECKNUMBER FEE flECEIPTNO. <br /> a,�8 <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDiNG ��'j�U �c� � � vV <br /> TYPEOFCOhST. NO.OFSIORIES at[UPAxtv NoofOWFwi.Guvrts <br /> cnou> pLUMBING ' <br /> SRE OF BLOG. FIPE SPRIHKLENS REO'D BASEMENT � <br /> MECHANICAL � <br /> ❑ YES C.' NO , <br /> OGCUPANCYLOAD FIREALAR41RE0'D HEIGMiLRdI1ATION AODITIONALPLANCHECK � <br /> i <br /> i <br /> OTHER � <br /> REASON ��" <br /> SiATE BUILDING SURCHARGE � ; �Ti <br /> y11 <br /> INTAKE BV PLANS FP?ROVE�BV CITY OF EVERETT PUBLIC WORKE ' <br /> LOCALSALES � <br /> o,,,E TAX CODE IS 3105 TOTAL �7�p I � <br />