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APPLICATIC�"'1 FOR CONSTRUC�N PERMIT �y�" <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> u HEATING SYSTEM: �GAS O ELECTRIC ❑ __ � i <br /> ta�� BUILDING DEPARTMENT <br /> � 259-8810 <br /> q` "� DEMOLITION COMBINATION BUILDING YMECHANICAL PLUMBING SIGN <br /> ��� UWNF.R '<`��n�> RIAILAUDFE55 GTY 21P PMONE — <br /> l/L <br /> c �aCCL (?.� .y.. .�R'�.10 !lo ��.�C" A�a. G.,.,s,i,�'�$'.LQ\ Z$1-01�OQ <br /> TENANT�— �1iLADDRE55 CITY 21P PMONE <br /> ��� J Q L,_/ �' <br /> 4RLNITEGiORDB5IGNER MAiLADORE55 CITV ZiP PHONE <br /> �� �_^�--.<< �I� <br /> �� GFNERRLWNTRPCTOR MAILA��Bl55 CIiY 2iP PMONF. SiAiELICENSE/ I <br /> [��� <br /> Q� �IEGNnNiCALCONLRACTOR I.IqRA��RE55 CIiV ZiP PMONE SiRTELICENSE� ��i <br /> w <br /> � <br /> � PWMBiNGCONTNACiOR MAiLA�DRES, CiTY ZiP PNONE ETATELICENSE� <br /> sH <br /> C"y <br /> CUSSOFWORN � <br /> � NEW �ADDITION � ALTERATION REPAIR DEMOLITION WOGDSTOVE/FRPL INSERT � � BUILDING RELOCATION <br /> H <br /> r� CnONTACT PERSON AND Pr�ONE NO n [2 <br /> �� CONTFAGTPRICEOFIYORN �? 'hQy� (1[ ���f - �d,"\�fJO I <br /> DESCRiBE YlORN�ND SOURRE FOOTAGE INVOLVED <br /> �� <br /> �� � <br /> -- -- PAocoseouseore wr i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS I <br /> ``��� 5��� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL �, <br /> � IEGAt�ESCFiPiIONOF PlIOPE �SNOW_f�fY N�EIOW ONRTTRCHfOUFCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF �, <br /> - WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OP � <br /> i.ot BLOCK oF NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE '� <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF AN'1 <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR'HE I <br /> - PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFOflM THE WORK FOR WHICH � <br /> APPLICATIOIJ IS MADE AND I COMPLY WITH THE STATE � <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> - %�� ---• \ -\`�-`i� i <br /> PRQIEGT rlOC9'c55 smv��uee o�*c ',, <br /> � �O y1��;��. ' <br /> � CirveuSw[Sst[[xsc xp '. <br /> '�1 PLUMBING MECHANICAL <br /> ,_' NO, TYPE OF fl%TUHE OR ITEM FEE NO. TYPE OF EOUIPMEM FEE <br /> WATER;LOSET(TOILET; 0.'�A�HNDLG UNITS—H.P. <br /> BATHTU6 FORCED AIR SYSTEMS—B.T,U. M E.A. <br /> ' + LAVATORY'WASH BASIN) � UNIT HEATERS—B.T.U. M I <br /> SHOWER CLOTHESDRVERS � <br /> '�I KITCHEN SINh 8 DISP VENTILATION FAN ; <br /> OISHWASHER RANGE HOOD <br /> ' � LAUNDRYTRAY ; _ __ WATERHEATEfI <br /> ' CLOTHES WASHEF' WOODSTOVE _� <br /> URINAL METAL FIREPLA^,E 8 CHIMNEY ! <br /> '� DRINKMG FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAII! HEAT PUMP r— <br /> �' � <br /> BACKFLOW PREVENTER; GAS PIPING <br /> � ROOF DRAINS—RAINLEAGSRS EXHAUST FAN T— <br /> f�1 SINK(SERVICE—BAR.ETC.) _ <br /> 1 — <br /> I�I SUB'J'AL S SUBTOTAL 5 � ''�' <br /> ' PEFMIT 5 PERMIT 5 <br /> \ � TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFIGE USE ONLY: <br /> FRONTSETBACK RERflSETBACK 9LESETBACN PLANCHECKNUAIBER FEE AECEIPLNO. <br /> '� 7J U <br /> USE20NE �otanen VACRATSITE FEES VALUATION FEE � <br /> BUILDING �i <br /> i1PE0fCOtItS.ALIOWANt[ ttPE0FC0951ACiWl Cccurutr broNc�u�".a:.+is i <br /> QP�`° PLUTABING <br /> SREOFBl06. NOOFSiORiE$ BnSEMENT !,�ECHANICAL <br /> OCCUPP4CYlOAO FIRESPPNKtEFSREOD NEiGNTLi1AiTRTi�N 4001TIONALPLANCHECK i_ I <br /> SPRINKLER � j <br /> a[nsor+Foasrair+rc�rns T— � <br /> STATE 9UILDMG SURCl1ARGE � <br /> INiANE DY �LANS AP�F�VEO BV CITY OF EVERETT PUBLIC WORKS � � <br /> LOCAL SALES � <br /> TAX COUE IS 3105 TOTAL � � <br />