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APPLICATIOO FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: 2rGAS ❑ ELECTRIC 0 <br />259-8810 <br />VDEMOLITION 0 COMBINATION ABUILDING ❑MECHANICAL ePLUMBING IJ SIGN <br />OMTIER WIAppR[55 CRY m PHONE <br />[TILL. R2AC�6.� f3'�I ! LLZikey-Ae'FU2Pa� �P2,01 358 T;EA <br />TENANT MAIAppREss Cm m PHONE <br />ARdIRECl OR DESA'ER <br />LIAA.ADDREss <br />CRY <br />ZIP <br />PHONE <br />J ��ra.a✓ F <br />�rza�,« rk <br />Lolt„-e� <br />g927 <br />425 7116i577 <br />GFNEMLLgRRACTCR <br />WE AGGRESS <br />CR', <br />ZIP <br />P E <br />STATE LCENSE9 <br />" <br />I. <br />lr7trHo/,z/4ae_ <br />YECHANC CCNTMCTOR <br />Wq ADDRESS <br />CRV <br />ZIP <br />PICNE <br />STATE LCENSE• <br />PLV481NGCCMRACTIXI WILADORESS CRY ZIP PICNE STATE LCENSE9 <br />CONTRACT PRCE OF N <br />4fea9 z9s <br />DESCRIBENCR«AROSOUMIEFOO WVCIVED <br />I2FI,R«,c n �! i!CNd/ F <br />CpITACTPERSONANO PI E f <br />F <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROP ERFQRM THE WORK FOR WHICH <br />APPLICATION IS M DE I COMPLY WITH THE STATE <br />CONTRACTORS LAW IB 7RC AND2 200WAC <br />,Y GG /y. <br />PRUPosED OBE oc BGIDINp <br />= <br />LEGAL DESCAIFICN OF PR EATY ISH DUCN OR ATTACH TA0 COPIFSI <br />LOT—DLOC« a <br />PARCEL TAX I D MIMBER <br />LONSTRIICTC4LW1 HOER. Apg1E5S. TElEPNCNE NUMBER (Q - Ep7-(p 32 <br />I <br />PROJECT ADDRESS <br />f',0I �a r'L n lur- F - - <br />«auIVAL wR T-- <br />fRTYNKAtp LtLNNM <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />I <br />WATER CLOSET (TOILET) <br />A/C—AIHNDLG UNITS—H. P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />IF <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK S DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />_ <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETD) <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT E <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRWSETDAC« <br />I <br />20 <br />REAR SETBACK <br />A <br />zo <br />SIDE SETBAL% <br />I <br />s ��o� <br />PLANCHE�K q <br />� s <br />FEE <br />a/9.7o <br />RECEIPT IIO <br />USEZONE —\ <br />CLOT Agw� ! <br />5 P <br />VACT SITE <br />AII <br />❑ YES O <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />lip 2/O <br />-3 .' 00 <br />TTNUCOKST <br />V —/L[ <br />NO OF STORIES <br />I <br />aPAMcr <br />Lw <br />Aa NPNUKRLNn <br />PLUMBING <br />SIEEGFBLDB <br />4150 S F, <br />FIRE SPAM RS RECTO <br />BASEMENT <br />ElYES31160 <br />MECHANICAL <br />i A lI <br />IT; <br />OCCUPANCY LOAB <br />FIREAIARNREOD <br />TWO,LLMHATCYI <br />ADDITIONAL PLAN CHECK <br />OTHER <br />REASgI <br />STATE BUILDING SURCHARGE <br />16D <br />WTANE BY <br />RLANSAVPROVEOBY <br />DATE Blj�, ig <br />CITY OF EVERETT <br />LOCAL SALES <br />TAY. CODE IS 3105 <br />PUBLICWORKS <br />' <br />TOTAL <br />