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APPLICATIQ"". FOR CONSTRUCT.`1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: � GAS J ELECTRIC ❑ —� <br /> 259-8810 <br /> ❑ DEMOUTION : COMBINATION ❑ BUILDING )�MECHANICAL �PLUMBING ❑ SIGN <br /> OWNER �AAILADDRE55 CITY ZIP PMONE <br /> �'vir�S� Ccc.v�v-.e�l �l`ds y 11� C lev� Hc�t_)ev� ��e�� � �t �`62cti3 25�'-1`�7 � <br /> TENANT MA!LADDR SS CIiY ZIP PMONE <br /> ARCHITECTOR�ESIGNER !'AIIADDFE55 QTv 21P PHON5 <br /> GENEflALCONTRACTOR MFILAO�FE55 CIiV ZIP PMONE STATEUCENSE� <br /> �MECH AL CONTRACiOR MAIL ADDRE55 CITV ZIP PHONE STAi�UGENSE 1'� <br /> .(�/�-C/'J <br /> PLUMBINGCONTRAGTOR MAILAOORESS CITY ZIP PIIONE STATELICENSEI <br /> CONTRACT PRICE OF WORK <br /> OESCRIBE WORK AND SUU4RE FOOTAGE INVJWED CONTACT PERSON ANO PHONS N0. <br /> _� C� �1n � a � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P.^�UPOSEDl15EOFBUILDMG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOTa� S�IPTIONOFB aPK RTY�SHO�NBELOWOr+G`��\��`ll�k`+ NOT. THELGRAN NG OF A ERMITJDO SENOT PRIESUMEETO GNE <br /> j/lAL4 � <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIUNS OF ANY <br /> �l l]S �Q `� �/� �� Z��-, 'i � i' �; A a �3 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%LD.NUMBEP � 7 ,� c CONTRACTORS LAW 18.27 W AND 296200 WAC. <br /> L` ��1 -6005 -C�� 00 � <br /> ' LONSTRUCTIONLOANLENDER.ADDRESS.TELEPHONENUMBER // <br /> X �lm1f L!i �/Q� <br /> PR CT ADDRESS , sm o�re <br /> . �jj W . �pY� \l,}i? .�r • �}�� cirveus•v�ssucervserro <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � WC—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 /> KITCHEM1 SINK 8 DISP ; VENTILATION FAN I <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATEA HEATER <br /> CLOTHES WASHEfi � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE�WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR ORAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> flOOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SEFVICE—BAR, ETC.) ; <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL 5 ' <br /> PERMIT $ PERMIT $ / � <br /> TOTALFEE $ � ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBpCN REAR SETBACK SIDE SETBACK PLAN CHE NUMBER FEE RECEIPT NO. <br /> S(�o <br /> USEZONE LOT�REA VACANTSITE FEES VALUATION FEE <br /> ❑ YES .7 NO BUILDING � <br /> TYPEOFCONST. NO.OFSTOAIFS acurnSGv AoormYnl�NGuxrts i <br /> ,F�uP PLUMBING i <br /> ----+- <br /> SREOFBLW. FIRESPRINKLERSREO'D BASEMENT MECHANICAL � � <br /> G YES '`7 NO � <br /> OCCUPANCY�OAD FIREAIARMREO'D MEIGHTUh11T�TI0N ADDITIONALPLANCHECK i <br /> i <br /> OTHER � <br /> FEASON i <br /> S7ATE BUILDING SURCHARGE � <br /> INTAKE BV PLANS APPROVEDBV CITY OF EVERETT PUBUC WORKS i <br /> LOCAL SALES � <br /> oA,E TAX CODE IS 3105 TOTAL <br />