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APPLICATIO� FOR CONSTRUCT�"'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: AS ❑EL[CTRIC � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i 1 DEMOLITION i COMBINATION :I BUILDING MECHANICAL P�UMBING i : SIGN <br /> OW MAII DDRE55 CITV 21F FNONE <br /> � ��a.-�(�E.-,S�i;� h �.�S�' ��r��fl� �!� �3 <br /> TPIANT MAILA� GTY 21P PHONE <br /> ARGRITECTOROESIGNER MAILPD�RE55 CITV ZIP PHONE <br /> GENERALCCNTRACTOR hIAILADDRE55 GTY ZIP PHONE STATEUCENSEv <br /> MECHAN� CW �A�OR�� _ � � � ��'� �� PH� _�y�E��,o��� <br /> � ��{�) l f.1 � <br /> PIUMPINGWNTRPCTOR ��AILADORE55 CIiV ZIP PHONE ST�AfELICENSEy <br /> CONTRFCT PRICE OF WORR ^ <br /> �. �/ - <br /> DESCR E WO K N OUAR TqGE INVOLVED CO PH NO. � <br /> � t � , � <br /> I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br /> PROPOSEOUSEOFBUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SNOWNBELOWORATTACHTWOGOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor eiocrc oF AUTHORITY �?O VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> nTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION AT I AM AUTHO(iIZED BV THE <br /> OWNER OF ' ROPERTY TO R ORM WORK FOF WHICH <br /> APPLIC M A I O WITH THE STATE <br /> PARCELTA%ID.NUMBER �a oOOO V �W O C/ CONTR 1B.Z AN ZJ6 WAC. <br /> CONSTRUCTIONIOANLENOEF.�DDREJS.TELEPNONENUMOEfl � /Il <br /> L/ <br /> PROJECTADORES `—� cNmm� o�rc — <br /> i _ <br /> Lc4 ca.ous��+cs ..r+s:no <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OP FUCTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—/UHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOF\'!WASHBASIN) � UNITHEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SRdK 8 UISP I VENTILATION FAN � <br /> D�SHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE�WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FI9EPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � , <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETQ) I � <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAI 5 ;� <br /> PERMIT y PERMIT $ � i <br /> TOTAL FEE $ ' TOTAL FEE 5 ' � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETOACK REAR SETBACN SIDE SEiBACK PL�N CMEC NUAIBER FEE REGEIPT NO. <br /> q�o <br /> USE ZONE LOT AREA VACANT SITL FEES VALUATION FE�� <br /> Cl YES u NO BUILDING <br /> 7VPEOFCONSi. NOAFSTOPIES atUC�NCv NOO�Ow[uiucuH��s PLUMBING � <br /> GFWv <br /> ��- <br /> SIZEOPOLDG. FIRESPRINKLERSFEO'D BASEMENT MECHANICAL � <br /> G YES ❑ NO <br /> OCCUPANCV LO�D FIP[AL�RM RW'D NEIGHTLIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER � <br /> REA.ON <br /> STATE BUILDING SURCHPRGE <br /> i <br /> intnKe ov rinNs nraqovEoor CITY OF EVERETT PU�LIC WORKS � <br /> LOCAL SALES <br /> �,,,,� TAX CODE IS 3105 rora� <br />