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APPLICATI�Mlf FOR CONSTRUC7v�JN PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK–PLEASE PRINT <br /> HEATING SYSTEM: Cl GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I DEMOLITION i � COMBINATI�N � BUILDING MECHANICAL _' pLUMBING D( SIGN <br /> OWNER / n <br /> MAILAUDflESS � CIN Zlg� PHONE <br /> �_F 7v�.�.,-,,�.f �7��ii�ir' ��iD /�//5 �`� �� �.o�- v3-iv�/ <br /> MAILAODRESS ��TY `/� Z�P�.�J PH E <br /> TENFNT p�� N yGC� /✓�G,/ ✓ � _" (�j� <br /> ��TI� D ��� F .d7.7L ��U pHONE <br /> ARCHITECTOROESIGNEfl MAILAODRE55 CITV ZIP <br /> GENERF CONTRACTOR MAIL ADOHE55 CITV ZIP PHOYE STATE L�CENSE A <br /> D/L�//VCLLS .?/ /�1 /.'t�__��`S �'�n`-�i, Wi�" 9l}�/'�U &�-5/77-7y5�10 /�,'I//NEILSn7Gd11/ <br /> MECHFNICALLONTRFCTOR MAILA�OFESS CITY ZIP PHONE STAiELICENSEN <br /> PLUMB NG CONTRFCiOR MAIL A��AESS CITY ZIP PHONE STAiE LICENSL M <br /> CLASS F WORN <br /> I I NEW � ''�. ADDITION '. '� ALTERATION , �. REPAIR �. DEMOLITION . WOODSTOVE/FRPL INSERT ��. BUILDING RELOCATION <br /> CONTACT PERSON ANO PHONE NO. <br /> ,r 1 � <br /> v <br /> CONTRACT PBICE OF WORN <br /> OEECFIBE WORN AND SOUARE FOOTAGE INVOLVED <br /> �310VC- 5/[NS 14dt7 "�bb �' SDO-�l77-7y�f <br /> PROPOSEDUSEOFBUILDI i HEREBY CERTIFY THAT I HAVE READ AND EX.AMINED THIS <br /> ii<T;�r/L �FT Suf�'/Ip S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 4 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGFLDESCFIPTIONOFPPOPEFTV(SNOWNBELOWORATfACHFOURCOPIES� y,�pRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOGK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> UTHER STATE OR LOCAL LAW REGULATING CONS7Rl�r,710N OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOfiK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> v /� '�/Jl'l,••�,� H->y-9,� <br /> sicrvnru�E onrE <br /> PFOJECTAODFE55 y�� <br /> /�D� SE ��j /v�� � cnvousinEssucervservo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT <br /> 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—[3.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDR�TRAY ' WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE 3 CHIMNEY ' <br /> DRINKING FOUNTAIN � FInEPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTEFS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> SUBTOTAL 5 ; PERr�OTAL � i <br /> PERMIT S ' <br /> TOTAL(�EE S ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO <br /> FRONT SEIBACK REAR SETOFCK SI�E SETBACN PLAN CHE NU�ER FEE � �J� �,��o <br /> C � <br /> VACANTSITE FEES VALUATION FEE <br /> USEZONE LOTFREA ?`� <br /> � — \ � BUIL�ING i_ <br /> 7Y°EOFGONTS.ALIOWABIE TYPEOFCONSi.ACiUAL oCCuvpr¢v ':OOronFwkGUNrtS <br /> GP0°P � PWMBING <br /> SRE OF BLDG. NO.OP S70HIES BASEMENT M[CHANICFL _ � <br /> i <br /> ADDITIONAL PLAN CHECK � <br /> OCCUPANCYLOAD FIIiESPRNNLER5RE0'0 HEIGHTLIMITAtION � <br /> . Uf�E_ SPFiINKLER <br /> REASON FOR SPflINKLERS i /� � <br /> STATE BUILDING SURCHARGE <br /> I4TAKE�V PLANS APPFOVED BY CITY OF EVERETT PUBLIC WORKS � <br /> J�n LOCAL SALES <br /> ,., �Z� /� TAX COOE IS 3105 TOTAL �j� ;'�� <br /> I - — <br />