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APPLICATI(�""'1 FOR CONSTRUCT`)N RERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION L7 COMBINATION ❑ BUiLDING f_l MECHANICAL C�LUMBING ❑ SIGN <br /> O'NGER �` I,IAILA��RE55 C�TY 21P PNONE <br /> o!/� lr�,fu6(�� ioio SE• E�i�nc�L.�,a�( wv � <br /> TENANT / /' MAILAUDRESS/� /� CITY � ZIP PHONE <br /> /7�v1 riCcn-c a� �`��a i1�c�� <br /> ARCHITECTOqDE51GNER ldAILAD�JRESS CI7Y ZIP PHONE <br /> GENERALCONTRACTOR I.IAILA��DFE55 CITY 21P PNONE S�ATE�IGENSEp <br /> �?�JOn/ CONS��c.�C //V�. <br /> IdECMANICALCONiPACTGR IAAILA[1DRESS CIiY ZIP PHONE SiFTELICENSEp <br /> _�/( 3ori�.D ���,�� /�r9z� w���nL��{ �v_ Stio 9��qo 6c��3»� �iCCS'a!'�Yo97� <br /> PLUMBINGCONTRACTOR MAILADDRESS CITV 21P PHONE STATELIC::NSEa <br /> CONTRFLT PRIGE OF WOfiK <br /> OESCFIBE WOPK AND SOUARE FWiAGE INVOWED pONTACT PERSON AND PMONE NO. <br /> GC�Lc�i <br /> i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORFECT.ALL <br /> PflOVISIONS OF LAWS AND ORDINANCES GOVERPIING THIS TYPE OF <br /> LEGAL�ESCRIPTIONOFPROPERTY�SNOWNBELOWORARFCHTYJOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN oF AUTHORITY TO VIOLATE OR CAPJCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEFiFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> PARCELTAXID.NUMBER APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br /> CONTRACTORS LAW 18.27� CW AND 296200 WAC. <br /> CONSTRUCTIONLOANLENOER,ADDRESS.TELEPHONENUIdBER IJ// / � / <br /> IliWJ� / 'sr�� <br /> PROJECT ADDRESS/O/C � rv /C�// G��` s��cNnrur�c _ oere <br /> G LIiV 905ME55lICE15E NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) � A/C—A/HNOLG UNITS—H.P. I <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(W4SH BASIN) U�IT HEATEFS—B.T.U. M <br /> SHOWER � CLOTHESDRVERS <br /> KITCHEM SINK& DISP - ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> — —�— <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DFlINKING FOUNTAIN � FIREPLACE INSERT � <br /> �-- <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ; <br /> � <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL S <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE 5 ; TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> PRONTSETD�CK FEARSET�4GN SIDESETBACK PLANCHE K U�MBER `,� FEE RECEIPTNO. <br /> J� <br /> usezorve LOTAREA vncnNrsrte FEES VALUATION FEE <br /> ❑ YES �i NO BUiLDiNG � <br /> TYPEOFLONSi. NO.OFS70RIES ottu�zHtY Na-0��NElurvGUNnS <br /> GDOP PLUMBING ' <br /> i <br /> SIZEOFBLDG. FIRESPRINKLERSFEO'D �ASEMENT MECHANICAL <br /> ❑ YES Ci NO <br /> OCCUPANCY LOAO FIRE�LARM REO'0 HEIGNT LIMITATION �+DDITIONAL PLAN CHECK <br /> i <br /> OTHER ' <br /> REASON <br /> � STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVEO BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES � <br /> onre TAX CODE IS 3105 TOTAL <br />