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APPLICATIQ`' FOI� COI�STM�UCT��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: i;}GAS a ELECTRIC ❑_ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑PLUMBING � I SIGN <br /> OWNER MAILAD�RESS CITY ZIF PHONE — <br /> �i ss �1,wv,F:v /4� GD.,�ea�a ,ad� Evke�i` 9d�0/ �a-�5��7 <br /> TENANT MFILFD�RE55 CITY IIP PHONE <br /> ARCNRE�TORDESIGNER fAAILAD�RESS CITY ZIP PHONE <br /> GENERALCONTFACTOR MAILADORE55 CITY ZIP PHONE STATE�ICENSEx <br /> �A�i�/�C - G/( f.�?k�EG .c�.r ��i` S�zv/ a�Sr^/sii �ucu=r oe�'.TiY <br /> MECNANICALCONTflACTOR MAILF�ORESS CITV ,ZIP PHOAE STATEUCENSEa <br /> PLUTABINGCONTRACTOR MFILFDDRESS CITY ZIP PHONE STATELICENSEa <br /> CONTRACT PRICE OF WCRK <br /> 8 57�- � .�7� <br /> DESCRIBE WORK ANO SOl1�FE FOOTAGE INVOLVFD CONTACi PERSON�ND PNONE NO. <br /> _ 9a� �rr..c�,� ,��a�ph r,�J2,��� as�-�s� <br /> ,- <br /> i HEREBti� CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CGRRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE O� <br /> LEGALDESCRIPTIONOFPROPEFiTV�SHOWNBELOWORATTACHTWOCOPIES) WORK WILL OE COMPLETED WITH WHETHER SPEGIfIED HEflEIN OR <br /> �or �s �r o BLOCK��— oF � —�n WOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GN[ <br /> AUTHORITY TO VIOLATc OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEflFORMANCE OF CONSTRUCTION.THAT I 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 /> PARCEL TAX I D NUMBER CONTRACTORo LAW 18.27 RCW AND 296.200 WAC. <br /> f o 00 0,� <br /> CONSTRUCTION LOAN LENDEP.�ODRESS,?ELEPHONE NUMBER <br /> ,�s�..��ll�i�� 7'/a�✓�r� <br /> PROJECT A DRESS sicu�mae oar <br /> biT Bt151N[SS IICENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—AIHNDLG UNITS—H.P. <br /> BATHTUFS FORCED AIR SYSTEMS—�.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEAT�RS—B.T.U. M1t ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP 4ENTILATION FAN � <br /> DISH WASHER RANGE HOOD �— <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ' <br /> FLOOR DRAIN HEAT PUMP � <br /> �ACKFLOW FREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; <br /> SINK(SFRVICE—BAR, ETC.) � <br /> � — <br /> � <br /> � <br /> � ; <br /> � <br /> SUB TOTAL 5 � SUB TOTAL S <br /> PERMIT $ PER�.11T 5 ; <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTS�CK� REARSET�K� SIDESET�� PLANCHEC��ER� FEE /� 'FECFIP�O.�� <br /> _� <br /> usezoNe IOTFREA VqCANTSITE FEES VALUATION FEE <br /> ,L-L ❑ YES I ! NO BUILDING � v /7 i — <br /> TYPEOFCONST NO.OFSTORIES attuvnbtv NoOrow[u'�mGu�urS <br /> � 6 o�Pl PLUMBING '7 �_ . <br /> �� <br /> SIZE OF BL�G. FIFE SPRINKLEflS REO'D BFSEMENT � � <br /> '`"►Oo SF GA • E. � =% YES f/Np MECHANICAL — � <br /> oCCUPAnCv nD FIREALAR a=_o'c HEIGHTur.urmoN ADDITIONALPLANCHECK � <br /> � �O �/ � OTHER i <br /> REASON ���� �_ <br /> STATE BUILDING SURCHARGE L/ ; i;/� <br /> --L_,�l L_ <br /> Wi�KEBV PLANS�ROV�DBV CITY OF EVERETT PUBUC WORKS � <br /> IV LOCAL SALES <br /> DATE 7 Zy� � TAX COUE IS 3105 rora� ; ,—� <br />