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APPLICATIC� FOR CONSTRUCT"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT �----- <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING ❑MECHANiCAL ❑PLUMBING ❑ SIGN <br /> OWNER �p MAILl�DDRESS J^Q CITVr 21P PHONE ^J//� / p'O�I[, <br /> K�fNI�D/I' IR.v�SR/Oq� �IV / ^L T/ f�/I/RJ/F ZI��f�L�PHONE T T/��U O /�/ <br /> p/l�CT�//�/�� MAI�`705���"i� ��f{D/if/��} 21P ��O�� PHON� �G �3�3 <br /> . �GENE LCONTNAGTO�q�/ MAILAnOORESS a CITV ZIPG PHONE/�[/ /S]TA/T�E�LI(CE'NSEN /� A <br /> C�CO�PAC/`RL�p•MAI A!�RW� �I/VAv� ��ITV �/�S'� ��O IV7? NAT�GJKR�IIOf/./�. <br /> PLUMBINGCONTMCTOR MAI A�DRESS CITY ZIP PHONE STATELICENSEII <br /> . CONTRACT PRICE OF WORK D /�O� / <br /> DESCBIBE WORK ANG SOUARE FOOTAGE INVOL D CONTACT PERSON ANO PHONE NO. CS O2 /�I�L• ]'S/�7� <br /> i� <br /> ,p 'iD ��� �. /N. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> � PROPOSEDUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND COFIRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESC PTIONOFPROPERTV(SHOWNBELOWOR ACHTWOCOPIE WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � � � '����� ��R; NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �or e�xK oF -T qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL U1W REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> TION ADE AND i COMPLY WITH THE STATE <br /> ' PARGEL TAX I.D.NUMBER CONTRA T S LAW 1 27 RCW AND 296200 WAC. <br /> 3 -� -ooG -�o/ <br /> , CIXJSTRUCTION LOAN LENDEP.ADDRESS,TELEPHONE NUMBER � \ <br /> � <br /> PROJECT AD S , /����J�J��'� SIGNA HE OATE <br /> � �/�� � F{�6��an�`� CITYOUSINESSUCENSENO. � <br /> � PLUMBING + MECHANICAL _ <br /> � Np, TYPE OF FIXTURE OR REM FEE NO. - TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � lV�A�HNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M � <br /> � SHOWER ' CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP ; VENTILATION FAN _� <br /> � DISHWASHER � RANGE HOOD ' <br /> �. LAUNDRYTRAY ; WATERHEATER � <br /> � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> � DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> i <br /> � BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> i <br /> SINK(SERVICE—BAR,ETC.) I � <br /> � <br /> � ' <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: 51H,o(4� J7��jC70 tZS � � �Z�� U�C- I 9�I I <br /> FRONTSETBACK REARSETBACK SIDE8ET9l�K PLANCHEC NUM9ER FEE <br /> �� . PECEIPT � <br /> �. �� �c 30 �l7• D � <br /> USE L LOT AREA 1'ACANT SITE FEES VALUATION FEE <br /> _ I 13�37� �, ves �No eu��o�r,� ��0 5C� D' — <br /> flPEOFCONST. NO.OFSTORIES OccUvaxCr r�o0�ow[urt+Guxns � <br /> I .Ll°'�Es PLUMBING � <br /> IG .7 , <br /> SIZEOFBLDG. FIRESPRINKI.ERSFEO'D BASEh1ENT ���� MECHANICAL � <br /> S ❑ YES L✓NO ; <br /> OCCUPANCV AU FIFE A�A M REO'0 HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> /J[�i � <br /> �� /�7 J OTHEF7 � <br /> i <br /> � <br /> FEASON �J <br /> STATE 6UILDING SURCHARGE ' <br /> i <br /> INTAKE BY PLANSAPP OV D BV CITY OF EVERETT PUBLIC WORK$ T- <br /> LOCAL SALES � <br /> oA7E S Z TAX CODE IS 3105 TOTAL i <br />