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APPLICATIC I FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRiry F <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•©O10 <br />El DEMOLITION ❑ COMBINATION 1-1 BUILDING ❑ MECHANICAL Cl PLUMBING 0 SIGN <br />OWNER MAIL ADDRESS CRY ZIP PHONE 1 <br />.r. In C _ _ ,I -- L. 5?.•„ ..i_7 I,rn CiCA•Lr,l <br />CITY <br />PHONE <br />..ow,.c� non ww MAn. ADDRESS CITY ZIP PHONE <br />11 .. <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />Jet) PYU\C <br />- <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE,INV LVED <br />CONTACT PERSON AND PHONE NO. <br />►fir F� R„Ix�71�0 J59-oo4I <br />�� awl <br />�>nl�ahil•�cY'i, <br />�PS bfT� s •')b5 4 - fD� <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PgOPOSED USE OF BUILDING <br />I.' I D PY\ 0_L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL D SCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COP ) <br />-\ b <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LorC 1� BLOCK of <br />AUTHORITY TO 11,0!-Ai E OR CANCEL THE PROVISIONS OF ANY <br />p • �f tL• 1 ��' O� -�V 'P� 1� J_ <br />LV <br />OTHER STATE Oli _OCAL LAW REGULATING CONSTRUCTION OR THE <br />THAT I AM AUTHORIZED BY THE <br />PERFORMANCE OF CONSTRUCTION. <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL T X I D NUMB <br />R <br />611E '*)a <br />�q— <br />- to j Z <br />,I' <br />SiGNYiUN <br />NS COTR CTIONsLOADER, AD RESS, TELEPHONE NUMBER <br />., � � TN LENDER, z <br />PROJECT ADDRESS <br />ii �1a - .Q <br />d-CJ O I <br />CrtY BUSNE554C[NSE NO. <br />PLUMBIN <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />Np, TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />AC—A/HNDLG UNITS—H.P. <br />' <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) it II <br />UNIT HEATERU. M <br />' <br />SHOWER <br />' <br />CLOTHES DRYERS <br />— <br />KITCHEN SINK 8 DISP <br />' <br />' <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />' <br />URINAL <br />' <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />' <br />-- <br />' <br />FLOOR DRAIN <br />I <br />_HEAT PUTAP <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />' <br />' <br />GAS PIPING <br />EXHAUSTFAN <br />, <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL $ <br />• <br />I <br />SUBTOTAL $ <br />I <br />' <br />PERMIT $ <br />PERMIT <br />TOTAL FEE $ <br />' <br />TOTAL FEE 5 <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK <br />Fl YES Fl NO <br />TYPE OF CO/NS1. <br />NO.OF STORIES <br />BCC~Y <br />NO WBNLUINB UNITS <br />V - ri <br />SZEOFBLDGG. <br />FIRE SPRINKLERS REOD <br />B❑ <br />O <br />YES NO <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIC4T LIMITATION <br />1'1 <br />N o <br />I PPROVED BY CITY OF EVERETT <br />TM I LOCAL SALES <br />PLAN CHECK NUMBER FEE RECEIPT NO. <br />VALUATION <br />FEES FEE <br />C <br />BUILDING <br />I <br />PLUMBING <br />T <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />I <br />OTHER <br />STATE BUILDING SURCHARGE ' <br />I <br />PUBLIC WORKS <br />