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APPLICATIC`1 FOR CONSTRUCT'"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION CI COMBINATION ❑ BUILDING Cl MECHANICAL I�PLUMBING ❑ SIGN <br /> OWNER MAII RODRE55 TY �/ ZIP PHONE <br /> F�uir_i S„���,� �71.' '„Z`) - nv6. �� �55a�'l �1Ro1� 57,5 4- �O'Jy <br /> TENRNT MAILAUDRE55 CITV ZIP PHONE <br /> ,b,�L,����K lUgo w tww/i �.a,�, �� Gg� l �l 2�33- 108� <br /> ARCMITECTORDESIGNER MRI�RDDRESS CITY ZIP PMONE <br /> GENERRLCONTRpCTOR MRILADDRESS CITY ZIP PMONE STATELICENSEt <br /> V�1 fYl� Caarancrm �?,io ��.� a+,G S.E �,�„ ae�s�_��;2�ts47 1►1M3)�'�j 1 D Dj�I <br /> MECHANICALCONiRRCTOF MAIUDDRESS CITY ZIP PNONE STATELICENSE� � <br /> PLUMBINGCONTRACTOR MAILADDRE55 LIN 21P PHONE STATELICENSEI <br /> CONTRRCT PRICE OF WORK <br /> • 000 <br /> DESCRIBE WORK AND SOUPPE FOOTAGE INVOLVED CONTACT PEPSON ANO PNONE NO. <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA�DESCRIPTIONOFPROPEFTY(SHOWNBELOWORATTRCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PE^MIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br /> PERFORMANCE 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 TA%I.D.NOMBER CONTRACTORS LAW 1827 RCW D 296.200 WAC. <br /> � � _� � <br /> CONSTPU ION LOAN LENDER.ADDRESS,iELEPHONE NUMBEN <br /> Ga <br /> PR ADDRESS s a are <br /> LIiY BlI5WE55 UCENSE NO <br /> LUMBING MECHANICAL <br /> NO, TVPE OF flKTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—N.P. <br /> BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> LAVATOflY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTIIATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WA5HER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST PAN � <br /> 51NK(SERVICE—BAR.ETC.) ; <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTAIFEE $ ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBALK REAP SETBACK SIDE SETBRCK PIAN CHECK ll BER FEE RECEIPT NO. <br /> � 553 <br /> USEZONE LOTAPEA VACANTSITE FEES VALUATION FEE <br /> J VES :J NO BUILOING � <br /> 7YPEOFLON57. NO.OFSTORIES aCuvaHtr ��oWVMwhGUNrts � <br /> ��"Z PLUMBING � <br /> SRE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL ' <br /> ! I 37 �'o .� YES _' NO , <br /> OLCUPANCYLORU FIPEALAflMREOD HEIGHTLIMITATION ADDITIONALPLANCHECK i <br /> 3 � /V� OTHER ' <br /> RERSON <br /> STATE BUILDING SURCHARGE i S� <br /> INTANE BV PUNS AP QVED BY CITY OF EVERETT PUBLIC WORNS � <br /> 'n LOCALSALES � <br /> onTe ` -�_ 5� TAl(CODE IS 3105 Tor�� � <br />