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APPLICATIQ`1 FOR CONSTRUCT''1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> V--� <br /> BUILDING DEPART EN1=� HEATIN�SYSTEM: i]GAS ;]ELECTRIC J �L <br /> 259-8810 l� <br /> I_I DEMOLITION` `/COMBINATION ! ! BUILDING ! ; <br /> J� MECHANICAL ;_� PLUMBING � 1 SIGN <br /> OWNER I R1AILADDRESS � CITY 21P PHONE <br /> �t) r l S c'�/l� /:�D/ C.is..> > �i%�a/ ��i�-� �.—, ��, � �Q �i�� 7 <br /> TENFNT MALADDRESS CITV ZIP PMONE <br /> AI:CHIiECTOR�ESIGNiR MFILAOOqESS GITV LP PHONE <br /> GENERA�C RACTOR MAILAODRESS CITY ZIP PHONE <br /> , .,^� � / STATEUCENSEa <br /> �11G(/l/ <br /> lAECMANI�ALCONTqqCTOF MFIIADDRE55 dTV 21P PHONE <br /> SiATE LICENSE/ <br /> PLWABINGCONTRqCTOR MAILqDDRE55 CITV ZIP PNONE <br /> STATE LICENSE p <br /> CONTRACT PRICE OF WORK <br /> ��soU <br /> DESCRIBE WORK AND SOUFRE FOOTAGE INVOL ED <br /> �7t � _ / �� � �� '�� ' � � �' '7 L /J1 � CONIDCT PEPSON AND PMONE NO. <br /> NJ <br /> n <br /> �V-�-� - 1.- .P.•O��l - 1N�cacRTc ) �� <br /> �'F,� SNt�� �6�`� CJ�AI-� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED� Uy�S�E O-,F,.��UILDING APpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> +-+-'�-Ly�r�'`�L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF �� <br /> LEGALDESCRIPiIONOFPROPERTV�SMOWNBELOWOORATTACNTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR I <br /> tor-�'—�-7,k o�p�K_� oF 1"/Ncrlue' �� .Di Y A_ NOT. T4E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THc <br /> PERFORAIANCE OF CONSTRUCTION.THAT I ARf AUTHORIZED BY THE <br /> �J '�� r � ��, _ (� _ OWNER OF THIS PROPERTY TO PERFORM THE WOFI( FOR WHICH <br /> PAPCERA%IA.NUMBEP APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTPUCTIONLGHNIEN�ER,ADORESS,TELEP�ONENbMBER ` ^ � <br /> PROJECTADDRESS / �/V7 n��7 � • �C ���1� �7u/ ! �/'1�'7� `>�-�� /� <br /> � ZO/ Vi i7.�/�tiLC�.O✓t�' Sim.�,�„� o.rc <br /> citv euswEss uc�rvsr:Ho � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OP FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC-NHNDLG UNITS-H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATC�RY(WASH BASIN) � UNIT HEATERS-B T.U. M � <br /> SHOWER � CLOTHES DRYERS , <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWhSHER � RANGE HOOD <br /> LAUNDRY TRAY ' WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRA�N � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF�RAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BqR,ETC.) � � <br /> � <br /> � <br /> _ ; <br /> � --T-- <br /> SUB TOTAL $ ; SUB TOTAL $ ��� <br /> PEflMIT 5 � PERMIT g <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiBACK qEAR SETBACN SIDE SETBACK PIAN CNECK N BER FEE RECEIPT NO. <br /> USEZONE LOTAPEA VACANTSITE F ES VALUATION FEE <br /> ❑ YES i� NO BUILDING X�t <br /> 1YPEOfLONSf NO.OFSTORIES OLCurA4cr uomo�xFwucwurs '/ / � <br /> caouc p�UMBING �/ / i <br /> i <br /> SRE OF BLDG. FIRE SPRINKLERS REO'D D�SEMENT <br /> MECHANICAL <br /> .'� YES �] NO �.� <br /> OCCUPANCY IOAD FIRE�L�Rh1 REOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> i <br /> R[�SON <br /> OTHER � <br /> STATE BUILDING SUPCHARGE �a,�� <br /> / <br /> INT�KE�Y PLANS�PPROVED OY CITY OP EVERETT pUBLIC WORKS � <br /> LOCAL SALES <br /> onTe TAX CODE IS 3105 TOTAL /�/ �—n <br />