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APPLICATIO./ FOR CONSTRUCT �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> DEMOLITION i COMBINATION BUILDING j(MECHANICAL PLUMBING SIGN <br /> OWNER MAILADDRESS CITV ZIP PHONE <br /> � � c1�.�i � .�r�'� S�,V L.v,v.d�vcv�� H/e 3l 7�f'� -/roGs� <br /> ���MMni L��iir�crn ��.a PHONe <br /> TENANT MAILADDRESS CITY Z�P <br /> S <br /> ARCNITECTOR�ESIGNER MAILADDRE55 CIN ZIP PHONE <br /> V`✓G r32ouctv/IY 32i�. ►a,i�r.,�,cRa.ir' :�✓��i':rn t�✓d `IB021 252-' G8�f8 <br /> GENERALCONTRRCTOR MAILADDRE55 <br /> CI1Y ZIP PMONE STATE LICENSE t <br /> ��n. Z�p PHONE`(Z•t�(�S�TATEUCENSE� <br /> M[LIIANI ALCONTRRCTOR MAILADDRE55 r� <br /> � ri 5.� ...� _� �o �r3N3N� is'n✓rF S J�i�n�.t�d 9B/3M 1f�r�N�s ��raur <br /> PIUTABING CONTRACTOP <br /> M�IL�ODRE55 CITV ZIP PIIONE STAiELILENSC <br /> CLASSOFWORK S��NKN�� ('�j{�I�C� <br /> � ' NEW XADD�TION �{ALTERATION �. REPAIR ' �. DEMOLITION � WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br /> CONiACT PERSON AND P110NE NO. <br /> CONTPALTPRICEOFWORK G � ~ �ZZ�y _ <br /> DE:•CFIBE WORK AND SOUARE FOOTAGE INVOLVEU <br /> PROPOSEDUSEOFBUILOING I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRIPTIONOFPROPERN(SHOWNOELOWORATfAGNFOURCOPI?.S� PROVISIONSOFLAWSANDORDINANCESGOVERNIN�THISTYPEOF <br /> �r WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT � p��yBLOCK (i/:Z oF R <<�? t' FJ.s" NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Lc��wt i�7 i� 'S � --Z OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ,OL= '�-D 5. APPLICATION IS MADE AN � COMPLY WITH THE STATE <br /> CONTRACTORS L9 .27 C ND 296200 WAC. <br /> 'i1E SL;2rl— 2 -000 5�G <br /> r�j <br /> 02./ -voo9 6G:29-�i1 - oiB—voo • 1 _�f/t "���� � '/C , �� <br /> D�i[ <br /> PROJECTAODRESS <br /> / . "^ n .f � � . C.V SINE LiCE Nti[NO <br /> PLUMBING G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG 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 ' CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAI�NDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE&CHIMNEY ' <br /> URINAL � � <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 /> � <br /> � <br /> SUB TOTAL $ 1; SUB TOTAL 5 ' <br /> FERMIT S —r PERMIT 5 � <br /> IOTALFEE 8 ' TOTALFEE 5 <br /> FOR OFFICE USE ONLY: aeceiar r+o. <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLAN�E���A,B�ER� FEE J �b ����J <br /> i�// <br /> '� rJ0 <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> 7VPEOFCONiS.AILOWAOLE 1"PEOFCONSi.AG1UAL Otcp�pt� AOIXVNFLLiNGUHrtS i <br /> PLUMBING <br /> SREOFBLDG. NO.OFSTORIES BASEMENT MECHANICPL � <br /> i <br /> OCCUPANCVLOAO FIRESPRNKLERSREO'D NEIGMTUMITATION /- (1 <br /> ADDITIONAL PLAN CHECK � <br /> . 5'RINKLER �CF' i 6 O ' <br /> REASON FOR SPRINKLEPS � <br /> SiATE BUILDING SURCHARGE � <br /> INTANE BV PLAN'APPPOVED BY CITY OF EVERETT PUBLIC WORKS � <br /> �� LOCAL SALES � <br /> TAX CODE IS 3105 TOTAL r,.; ; ,�^ <br />