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APPLICATIQ"1 FOR CQNSTRUCTf `N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ,X�GAS J ELECTRIC 'J <br /> BUILDI�IG DEPARTMFNT <br /> 259-8810 <br /> DEMOLITION i_; CO�dBINATION BUILDING XMECHANICAL [_', PLUMBING J �1GN <br /> LOW,NEF I.IFhADDqE55 CrtY ZIP PHONE <br /> LILCE1,4Ei, rU/CKe.PSDA /OL6 HOYl�4riE CUE�c"7T 9117n/ 2SL•6�/�(� <br /> ?EkAYf I.IqILADDFE55 .^,rtY ZIP PHGNE <br /> APCMRECT OR�ESIGeER IAAIL AODRE55 CITV ZIP PHONE <br /> GENERALCONTRACTOP MAI�ADORE55 CITY ZIP PHONE STATELICENSE> <br /> MECMAMJAL CONTRACTOR IdAIL ADDiiE55 QTV ZIP PYONE ST>TE LICENSE a <br /> t'U�aP� c�k.: i,uc�4�z/ e S��A�r W `YNrilr,aoop �Jq 9�a36 �N os�A� cU2oPCL�/0 4N <br /> PLUTABINGCONTRACTOF MAiIADDFESS CITV 21P PHONE STATELICENSEp <br /> CONTFACT PPILE OF WORN <br /> ��3.f"�,oo — <br /> �ESLRIBE WORK AND SOUAF.E FOOTPGE INVOW ED CONiAGT PER50Y AND PHONE N0. <br /> �h.c�Z��w�ie� � C� �u. <br /> W� h.C�A-�,f i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEDUS�OF BUILDING ppp�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISICNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL�E3LRPTtONOFPRJPERN�SHOWNOELOWORATfACHTWDCOP1E51 WORK WILL BE COMPLETED 1'JI7H WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING 0� A PERMIT DOES NOT PRESUME TO GIVE <br /> i0i — BLfKK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEH STATE OR LOCAL LA4V REGULATING CONSTRUCTION OR THE <br /> PERFOR�IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY,TO PERFORM 'fHE WORK FOR VJHICH <br /> APPLICATION IS MADE ANO I COMP Y WITH THE STATE <br /> PABCELTA%I.O.NUAIBEF CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> 20NSTF7CTIOn'IOANLENDEF.A0�RE5S,TELEPHONEN01dBEF O/ ^ / _ <br /> /.�. �[/' i•�/• 9S� <br /> VV N'�^ <br /> PRO�J/ECT AD(D�RE:�S sicnnruae � o�'E <br /> IOUiJ �IOY C GRVBUSiNE55UCBlSENO <br /> PLUMBING MECHANICAL <br /> NO. �'YPE OF FIXTURE OR ITEM PEE NO. TYPE OF EOUIPMENT FEE <br /> WATER�;LOSET(TOILET) � A'C—A�HNDLG UNITS—H.P. <br /> 6ATHTL6 ; / FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATCRY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWf:R � CLOTHES DRYERS <br /> KITCHf:N SINK&DISP VENTILATION FAN I <br /> DISHN.ASHER � RANGE HOOD � <br /> LAUNhRY TRAY ; WATER HEATER ' <br /> CLOTI�IES WASHEfl WOOD STOVE <br /> URINr,L METAL FIREPLACE(WOOD BURNING) ' <br /> DPIN tING FOUNTAIN FIREPLACE INSERT � <br /> FLOC�R DRAW � HF.AT PUMP <br /> BACI;FLOW PAEVENTERS ; GAS PIPING � <br /> ROCF DRAINS—RAWIEADERS EXHAUST FAN <br /> S W f.(SERVICE-8/.A,ETC.� � <br /> � <br /> � <br /> SUB TOTAL $ SUB TO?"AL S ' � <br /> PERA1iT 5 PERMIT 5 � � <br /> TOTAI FEE S ' TOTAL FEE 5 � <br /> FOR pFF'ICE USE ONLY: <br /> FRONTEETBA:N REPHSET�ACK SI�ESETBAGK PLANCH RNU BER � FeE AECEIPTNO. <br /> ��J � <br /> lISElONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES . i NO BUILDING ' <br /> TVPEOFWNS. NO.OFSTORIES oG;uvF4Gv n00�ttxuuM1,w�nS � <br /> eeouv PLUMBING � <br /> SIZEOFBLC'3. FIRESPPINHLEFSREO'D BASEMENT MECHANICAL __�1_ <br /> ❑ YES � NO <br /> AODITIONPL PLAN CHECK � <br /> OCCl1PANCYLOAD FIR[�LARIARE00 HFIGHTLIMITATION — <br /> OTHER <br /> _ �T <br /> REn50N <br /> . STATE BUILOING SURCHARGE <br /> uirnkce r�nNsavvnov�oav CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES �— <br /> o.orF TAX CODE IS 3105 TOTAL ,j; �' <br /> � <br />