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APPLICATIO'J'` FOR CONSTRUCTIAN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILOING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ 1 <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfi � MAILAOORESS�J//!/�'/ CITV 21P PHONE <br /> �1 � � �I GY(/v <br /> c�c�Iol�• /�a7fzo/t/ }Uac /�c�v/r�i �7.. F�7� 9�206 3S7-o�oy <br /> TE ANT MAILAUDRE5/5j —/ --� GITV ZIP PHONE <br /> �1'V �Si �G 3/ Il-C7WlMMc` L�✓/r'I/T �? /Q.70 � �-+ Il �W.�7� <br /> AR�HIT CTOqDESIGNER MAILADORE55 qTY ZIP PHONE <br /> GENEFALCONTRACTOR MFILADDRESS CITY 21P PHONE STATELICENSEp <br /> MECHANICALCONTRACTOR MFILADDRESS CITY ZIP PHONE STATELICENSEq <br /> f')���me.�J <br /> PL BINGCONTRACTOR MAILA��RESS CITV 21P PHONE STATEUCENSEM <br /> CONTflACi PRICE OF WORH <br /> D�RIBF WORK AND SOUAflE FOOTAGE INVOLVED � � CONTACT PERSON AND PHONE NO. <br /> vy <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PqOPOSED USE OF BUILDING APPLICATIOM AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDI!JANCES GOVERNING THIS TYPE OF <br /> LEGALDESCR!PTIONOFPROPER�`/�SHOWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> J�/ �a�6d�� v P � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF GONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOfi WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRACTOFS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRl1CTIONLOANLENOFR.ADDRE55,TELEPHONE NUMBEA <br /> / <br /> PROJECT A �SS �n `� uAe o�te <br /> ' U <br /> CIiY USINESSLICENSENO. <br /> PL MBINfa MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPh1ENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS--B.T.U. M � <br /> SHOWER ' CLOTHES ORYERS � <br /> KITCHEN SINK 8 DISP � VE�'TILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER i WOOD STOVE � <br /> UiiINAL ; METAL FIREPLACE(WOOD BURtJING) � <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 /> SUB TOTAL S ; SUB TOTAL 5 ; <br /> PERMIT $ � PERMIT S � <br /> TOTAL FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESET9ACN PIANCHECKNUMBER FEE RECEIPiNO. <br /> USEZONE �OTAPEA VACANTSITE FEES VAL'JATION FEE <br /> ❑ YES ❑ N� BUILDING <br /> � <br /> TVPE�FCONST. NO.OFSTORIES O[CUPeNcv NOO�oWEluNcuNirs . i <br /> �A0°P PLUMBING � <br /> S�ZE OF 91.DG. FIRE SPRINKLERS REO'D BASEMENT � <br /> MECHANICAL <br /> L YES ❑ NO <br /> OCCIIPANCYLOA� FIflEALARMREO'D HEIGNTLIMITATION ADDITIONALPLANCHECK <br /> i <br /> OTHER � <br /> FEASON i <br /> STATE EUILDING SUFCHARGE <br /> INTAKE BY PLANS APPROVEO BV CITY OF EVERETT PUBLIC WOFKS � <br /> LOCALSALES , <br /> onre TAX CODE IS 3105 TOTAL ; <br />