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` ` APPLICATIC"'] FOR CONSTRUCT'�N �T <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> � aU <br /> HEATING SYSTEM: AS ❑ELECTRIC ❑ '"'•^••,..... • <br /> BUILDING DEPARTMENT � • � ....,,� <br /> 25n-asio � �� E�fRE�"` <br /> 1 DEMOLITION i ; COMBINATION I BUILDING !�?'MECHANICAL ' L�f� f ' iJ SIGN <br /> R AIt qD�RE55 CITY ZIP PHONE <br /> t:�ti ' � '-1� .'��,�Plll1r'� ��P�-� �r' f-0cr%ff �%k���O �:� •�.�`% - �/G•C'' �� <br /> T� iFn; MFII ADOFE55 CIN ZIP PHONE <br /> �'`\ <br /> A�ITE�OPDF.SIGN[R MFILADDRESS CITY ZIP PHONE <br /> � <br /> GF.�jE�AILONTRACTOR MAILRDORE55 CITY ZIP PHONE STATEUCENSEa <br /> Id f\ <br /> HANICALCONTRACT MAILFODRE55 CIiY 21P PNONE STA7EUCENSEM <br /> �tZl���lit� '�P����,1�i ��L((� I � � ���I�� ��I ��1'� �.Ic, �l �//,� ._?yF'- 7iCc� i�h�C/VNNCU �7^� <br /> PLUMBINGCONTRFCTOR MAI�A04RE55 CI7V ZIP PHONE STRTELICENSE� <br /> L <br /> CONTRAC,PR�CE OF WORK�� <br /> )`�C� .�. <br /> .DESCR E WO AND SOIIARE F� TAGE INVOLVED • C N T PERSON AND PHONE NO l �. <br /> � �(. �A'�. • �\\ �I( � �l.C� � �{ � � r� � <br /> �� ' •� ';r - <br /> I HEREBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br /> •aa SEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA OESCRIPTIONOFPROPERNISNOWNBELOWOFATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BIOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ola THE <br /> PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B'�THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> pne e jAY/D °�MFER CONTR ACTORS LAW 1827 RCW AND 296.200 WAC. <br /> '�l�t / ' '�(�' " ��j , ' ` - ^I \ <br /> CONSTRUCTIONLORNLENDER,AODRESS.TELEPHONENUMBER �1 / � <br /> ,� '�. � � � �,� � �c< <, I� /���,</ <br /> PROJECT ADDRES sicN.run� `'— o.re <br /> 7. `j � u*vouswcssucEr+seHo <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMFNT FEE <br /> WATER CLOSET(TOILET) � !UC—NHNDLG UNITS—H.P. p�" <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U.I° E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES URYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CIOTHES WASNER � WOOD STOVE � <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 /> � � <br /> � � <br /> I � <br /> SUB TOTAL S ; SUB TOTAL $ . <br /> PERMIT $ � PERMIT 5 � � <br /> TOTAL FEE $ ; TOTAL FEE 5 -f~`v <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiBACK RERRSETBFCK SIDESETBACK PIANCHE KNlIM9ER FEE FECEIPTNO. <br /> �-a_�� <br /> use zoNe LOT AREA VACFN7 SITE FEES VALUATION FEE <br /> ❑ VES i� NO BUILDING <br /> iYPE OF CONSi. NO.OF STORIES OCLuveNcr Na Oi�wEluxGUNIiS � <br /> pPppP pLUM81NG i ' <br /> S2E OF BLDG. FIRE SPRINKLERS REO'D O�SEMENT MECHANICAL 1 <br /> f7 YES ❑ NO � <br /> OCCUPANCV LOAD FIRE ALARM REO'D NEIGHT IIMIiAT10N ADDITIONAL PLNN CHECK � <br /> � <br /> OTHER <br /> REASON <br /> . STATE BUILDING SURCHARGE i <br /> INTAKE BV PLANSAPPROVED BV CITY OF EVERETT PUBLIC WORKS � <br /> LOCALSALES , " <br /> oare TAX CODE IS 3105 T�TA� ' <br />