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APPLICATIC~� FOR CONSTRUCT: )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC U <br /> 259-8810 <br /> i ! DEMOUTION C I COMBINATION BUILDING �G MECHANICAL .�j,PLUMBING L] SIGN <br /> OIYNER lAAILADOFESS GITY 21P PMONE <br /> �.l1RI�Pa�v� C�rab�i^ 1'l0l 1-�til7" EGe�^e�" i.�'� ��8�1 '��8 ����3 <br /> TEN�NT MAIL�D�RESS —�� CITV 4L ZIP PNONE <br /> �n��,R�,F►JC� MAN�3G����.�tT �1�_,) ����Rc�t'rpwP� �5�.2c1 �5r—���� � <br /> ARCNITECTOR�ESIG R MMLADDRESS CITY—� 21P pHONE <br /> GENERAL CONTRACTOR MAIL ADOPESS CITV 21P PHON[ STATE LICENSE• <br /> MECHANICAI.COI:TBACTOR MAILADDFESS G7Y ZIP PHONE STATEUGENSE• <br /> PLUMBMG CONTRACTOR MAIL AODRESS LITY ZIP PNONE STqTE IICENSE r <br /> Nu •�hFr,� FnF����l � � �,E: �:�.- 'r'�''P+ �ct �� t�� �8��'8 3s�3s�s� NoRrr��z133�7 <br /> GONTRACT P GE OF WORKu V <br /> / <br /> OESCRIB��s WO (AND SOUARE FOOTAGE INVOLVED ^ CONTACT PEFS N AND ONE N0. <br /> y li � � i'1 . � I 1 1 I J�� �SJ� <br /> 'uyy— <br /> i r� � l� �-C l-l�'r'YI f t Iv� �.> - C <br /> I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> PROPOSEDOSEOPBUILDING APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCFIPTIONOFPROPERTV�SHOWNBELOWORATfACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PfiOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT�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 /> PqPCEL TA%ID.NUMBEB CONTi7ACTOHS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUG710NLOANLENOER.ADORESS.TELEPHONENUMBER <br /> ►�i n ? �vp�� t-k- �„� ,�;•, ,zrn"t'� fo`:��-�� _ <br /> PROJECT ADDRESfi srn �une o��e . <br /> crtv nusw[ss uce��sc Ho <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FE� <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8�ISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ' WATEF HEAT[R <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> FOOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR, ETC.) � � <br /> � � <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S 1 <br /> PERMIT 5 � PERMIT 5 <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK REARSET�ACK SIDESETBACK PLANCNECNNpA1B�� FEG RECEIPTNO. <br /> L.-�Y � <br /> USE ZONE �or naen VAC�NT SITE FEES VALUATION FEE <br /> -: YES :7. NO BUILDING <br /> iYPE OF LONST NO.OF STOFIES afurpi¢v so Or ew¢uHGutinS � <br /> ccoc� p�UMBING � <br /> SRE OF BLDG FIRE SPRINKLERS REO'D BASEMENT MECHANICAL <br /> -�. YES ��:'�. NO -- <br /> OCCUPANCYLOAD FIFF.ALARMRCOD NEIGNTLIh1R4T10N ADDITIONALPLANCHECK i <br /> OTHER <br /> REASON <br /> STATE Bl11LDING SURCHARGE <br /> INTAK[�Y PLANS APPROVED OY CITY OF EVERETT PUBLIC WORKS <br /> LOCALSALES <br /> onT� TAX CODE IS 3105 TOTAL <br />