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,�PPLICATI�1 FOR CONSTRUC°:�ON PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �..�"�s�sr <br /> C�--- <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS LECTRIC ❑ <br /> 259-8810 <br /> I_1 DEMOLITION ;_I COMBINATION ,� BUILDING ! ;MECHANICAL �PLUMBING I 1 SIGN <br /> OWN R IL ODRE55 C ZIP PHO <br /> _ �t ��.iNdA �Aunhnl 41,,�''� �IeNN��l�ncl Mref� �5�-?'/� 1 <br /> ItNnNT MAILADURESG�I CITV ZIP PHONE <br /> ��1GECERALCONTRESITOER MAILADDRE55 CITM Z�P PNONE <br /> � 190 I'7� 6i5EAu�l1,��� PHONE STATELICENSEI <br /> �►n �PI' TstC' . �e i ��-►-t,�i tN ��-r//�I �V���R �o� PN <br />, MECNANICAL CONTRACTOR MAIL ADDRE55 CIN IP PNONE STATE LI E� <br /> PLUMBING CONTflACTOR M� RE55 CITV ZIP E STATE LICENSE I1 <br /> ClAS50F WOR <br /> f 1 NEW ' I ADDITION I i ALTERATION . �� REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT � I BUILDING RELOCATION <br /> � OO CONTACT RSO ND PHONE NO. � <br /> CONTRACT PRICE OF WOflN <br /> ' DE RIBE WORK ANO SOUAq FOOTAGE VOLVED ` ' <br /> c�����:�,_. I � ��.-��v 1 �� - r!!lo <br /> PROP EDUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ ANG EXAMINED THIS <br /> `. APPLICATION AND KNOW THE SAME TU t1E TRUF AND CORRECT.ALL <br /> LEGALDESGRIPTION OF PROPERTV(SHOWN BELOW ORATT�CH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETEO WITF� WHETHER SPECIFIED HEREIN OR <br /> i�i� e�ocK oF NOT. THE GRANTING OF A PERM:T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOIJS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULITING CONSTRUCTION OR THE <br /> , PERFORMANCE OF CONSTRUCTION.Th.4T I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP O PERFORiA THE WORK FOR WHICN <br /> APPLICATION IS MA E AN I COMPLY WITH THE STATE <br /> CONTfi RS LAW 7B. RCW A D 296.200 WAC. <br /> 0 0 <br /> - �J U <br /> PRQIECTAODF�E$5�� /"�1���� A , � sicHniu onte <br /> rT V 4��i� <br /> Ci1 V IIUSINCSS IiCENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. I <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&DISP ; VENTILATION FAN ' <br /> _� DISHWASHER � RANGE HOOD � <br /> . LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ; <br /> • URINAL � METAL FIREPLACE&CHIMNEY � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> S�NK(SERVICE—BAR.ETC.) ; <br /> � ; <br /> i , <br /> � <br /> � , <br /> SUB TOTAL $ ; SUB TOTAL $ _� <br /> PERMIT 5 � PERMIT S ' <br /> TOTAL FEE S � TOTAL FEE 3 � <br /> FOR OFFICE USE ONLY: �p(� , c�� <br /> FPONiSETBACK REAflSETBACK SIDESETBACK PLANCMECKNlIh1BER � FEE RECEIPT 'J. <br /> , � / , � � ����/ <br /> u5e7oNE LOTARE� VACANTSI FEES VALUATION FL•E <br /> R + � BUILDING 3a�77�+ �/�i Q✓ <br /> TVPEOiLONiS.RIIOWABLE NPEOiCON51.AtiUAL at[uvu�a h00im5FwN6urut5 i— <br /> F � <br /> _�J _ � � PLUMBING �- � — <br /> i <br /> SIZE OF BLOG NO.OF STORIES BASEMENT .- i <br /> GO p Sf P/71Z Z D MECHANICAL �r� � — <br /> OCLUPAflCVLOAD FIRESPRNKLERSREO'D HEIGHTIIMITATIO% ADDITIONALPLANCHECK � -� <br /> n Nv � SPRINKLER � ( <br /> FEASON FO SPflINKLERS � - <br /> STATE BUILDING SURCHARGE ; J <br /> INTAKE BY PLANSAPPROVEDBY CITY OF EVERETT f'UBLIC WORHS �� <br /> `J N" LOCAL SALES � ' <br /> � � TAX CODE IS 3105 TOTAL ��� � �,f <br />