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.. � ......��. ��r� �.. �. .�-i'Y..���... . <br /> APPLICATII�I FOR CONSTRUCI ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> p�DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfl MRILRDORE55 CITY 21P PHONE <br /> �Alrl.E �I�RDwAXE ll3Z'! 3fl�a RvG ►�- O.e.at �82cY <br /> TENANT MAIL ADORESS CITY ZIP PMONE <br /> ARCHITECTORDESIGNER MAILADDRESS CITY 21P PNONE <br /> ' GENERALCONTRACTOR MAILAODRESS CITY ZIP PHONE STATELICENSEI <br /> Sl�"�RiLlk COK�C'. GO. ' <br /> MECMANICQCONTRACTOfl MAILADDRE55 CITV ZIP PHONE STATELICENSEI <br /> PLUMBIN(3CONTR�CTOR MAII�DDRE55 GTV ZIP PMONE STATEIICENSE� <br /> CONTRACT PRICE OF WORK <br /> DESCflIBEWORKANOSW�REFOOTAGEINVOWED CONTACTPERSONANDPMONENO. � <br /> in.0 0( 3 <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEOALOESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPE:IFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT f�RESUME TO GIVE <br /> �or BLOGh oF AUTHORITY TO VIOLATE OR CANCEL THE °nOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTiiUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THF WORK FOR WHICH <br /> PARCEITA i.o.Nu ER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> .�G�'�_��� �«�3 CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN lENOER.ADDRE55.TELEPHONE NUMBER S <br /> PROJECT ADDRES � �� n srorutune , wre T'�" <br /> µ�' CiTv BUSmE55 LiCEHSE'q. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � AIC—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 ' CLOTHFS DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> T <br /> URINAL ' MET.4L FIfiEPLACE(WO00 BURNING) � <br /> DRINKING FOUNTAtN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF ORAINS—RAINLEADEHS � EKHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; <br /> � i <br /> � � <br /> � � <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLV: <br /> FpONTSETtlACN flEAR5ET8ACN SIOESETBACN PLANLHECKNUMBER FEE pECEIPTNO. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> ttPEOFCON57. NO.OFSTORIES aaw�xcr xo.aovrtuir�cuxirs i <br /> GPO�v PLUMBING � <br /> SIZE OF BLDG. FIRE SPRINKLEPS REO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO , <br /> OCCUPANCY LOAD FIRE AURM flE0'D MEIGHT LIMITATION ADDITIONAL PLAN CHECK j <br /> OTHER ' <br /> i <br /> REASON <br /> STATE BUILDING SURCHARGE i <br /> INTANE BY PlANSPPPROVEDBY CITY OF EVERETT PUBLIC WORKS i <br /> � LOCAL SALES , <br /> DATE TAX CODE IS 3105 rorn� � <br />