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APPLICATIO�FOR CONSTRUCTIC�''y PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS p ELECTRIC G —� <br /> 259-8810 <br /> ::� DEMOUTION ❑ COMBINATION ❑ BUILDING �MECHANICAL C PLUMBING ❑ SIGN <br /> OWNE;�F MAILAD�D1RE55 r ��,1 CITY Z.�IP.{s�,.� PHONE <br /> T6HAN���— IOL�iOSNG 1-OIn�O IJo.y.MJ C��1�IQA4 ZI� `^i�� �O E�Q \W <br /> l <br /> AFCNITECTORDESIGNEP MAILADGRE55 CITY IIP PMONE <br /> GENERALCONTRpCTOR MAILADDRESS p7Y ZIP PMONE STATEIICENSEY <br /> MECHANICALCONTRACTOR MAILADDRESS QTY ZIP PMONE STATEUGENSE� <br /> �ca�iza u��;n� 3G,01 1�ISr5� SW Lvnnwn� � 9�(73h 7y5�30 I�ORI'LNrt�f7D(1 <br /> PIUMBINGCONTflACTOR MAILADDRESS CIiY ZIP PMONE STATCII'ENSE� <br /> GONTRpC�.P f.E O,PrWORN <br /> �'Y ` �� 4 "�3 i'1��J�a; <br /> DESCRIBEWORKANDSOUAREFOOTAGEINVOLVED CONTACTPERSONANDPMONENO. '1� �ys �q30 <br /> r <br /> lwll 3 �r r <br /> 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILOING APPLICATIC� �AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIOh„OF LAWS AND ORDINANC:S GOVERNING THIS iVPE OF <br /> LEGALOESCRIPTIONOFPROPEPIY�SMOWNBELOWOflATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or etocK pF NOT. THE 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 THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAflCELTAXI.D.NUMBER APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> GONSTRUCTION LOAN LENDER,ADDRE55,TELEPMONE NUMB[H <br /> Pf�JECTADDRESS� � �' � ���_�3 <br /> ,wr��AE o., <br /> cii.nusmcss ucrvsc�.o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM PEE NO. ' TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—A/HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.II. M E.A. <br /> LAVATORY(WqSH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS , <br /> KITCHEN SINK R DISP � ; VENTILATION FA4 <br /> � � DISHWASHER � 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 DRAIN - HEAT PUMP �— <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF�DRAINS—RAINLEADERS EXHAUST FAN <br /> �SINK(SERVICE—BAR,ETC.) � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL S ��✓ ' � <br /> PERMIT S � pERMIT $ � " <br /> TOTAL FEE S TOTAL FEE $ �� � ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETI3ACK REARSETBRCK SIOESETOACK PIANGME H�M�� fEG RECEIPTND. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILo1NG <br /> tVPEOFCONSt NO.OFSTORIES atoos�ucv xowow[wxcuRrts <br /> cxauo pLUMBING <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO <br /> OCCUPANCY LOAD FIRE AIARM REOD NEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTH[R � <br /> STATE BUILDING SURCHARGE � <br /> ��i' � PLANS P�eo av CITY JF EVERETT PUBIIC WOftKS <br /> LOCAL SALES <br /> on —a� _ �� TAX CODE IS 3105 TOTAL � <br /> � <br />