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pppLlCe3ia'"� FOR CONSTRUCT''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ I <br /> BUILOING DEPARTMENT — <br /> 259•8810 <br /> ❑ DEMOLITION !.l COMBINATION I 1 BUILDING :1 MECHANICAL Cl PLUMBING X SIGN <br /> Q�Eq�VE��rT- MAILADDRESS CITV ZIP PMONE <br /> ppydd��4nwN S�ow►r dt'roo N'Ew.tr-A��=v�'a6tT 48zob �s9 -�/o� <br /> TEN�NT TM�ILADDRESS CITV ZIP PHONE <br /> APCMITECTORUESIGNER MAIIRDDRESS CITV ZIP PNONE <br /> „ . e.,,, r.,. . s �, W� 9Pv�sc 77b-8�'3S <br /> ��"bR)'%VGONLo ru n �v �� yi�nwo0d � <br /> GENERALCONTR�CTOR M�IL�DDRf.55 GITV 21P PHONE STATELICENSE� <br /> 1��.6y'�`�N � i?o.(30k'S'169 '—�jlNy '^'oo� Wl4 fFONL 77G6�'3SaE'�2KYNco'77�M <br /> � MEGMANICALCONTRRGTOR MAILADDRESS CITY ZIP PHONE STATEIILENSE• <br /> PLUMBINGCOFITR�CTOR M�ILADDHE55 CITY 21P PNONE STRTEICENSE� <br /> CONTR�Ci PRICE OF WORN <br /> DESCRIBE RK AND SOU4RE FOOTAGE INVOLVED CON CT PERSON A PNO O. p p� <br /> r� v °-' <br /> a - p it�i� <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS . <br /> � PROPOSED U�SE OF BWLDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S '„� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE6ALDESCNIPTIONOFPROPERTVI ����OWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � ipT eiocK � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> (�� L f OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> SC� a�^'��-^�-'O - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> � i P�NCEL TA%I.D.NUAIBER H378_bqo�ppl .0 Oo3 CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> , ' � CONSTRUOTION�O�N LENDER.ADDHESS.TELEPHONE NUMBEH � _ � a� '7+ S"/ Y <br /> �O o�TE <br /> � ' PROJECT ADDRESS s:cN�rune O.TY>pb <br /> Cw V E• rV��I`Q� OiVBU5ME53lICEN5EN0 <br /> � � PLUMBIN6 MECHANICAL <br /> ' FEE N0. TVPE OF EQUIPMENT �E <br /> Np, TYPE OF FlI(TUHE OR ITEM q��qiHNDLG UNITS—H.P. ' <br /> � WATER CLOSET(TOILET) , <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANOE HOOD ' <br /> � WAtER HEATER � <br /> LAUNDRYTRAY � WpODSTOVE <br /> CLOTHES WASHER ' � <br /> � METAL FIREPLACE(WO00 BURNING) <br /> URINAL ' <br /> � DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFIOW PREVENTERS ' GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � <br /> i "T— <br /> SUB TOTAL $ ' SUB TOTAL $ <br /> PERMIT $ � PERMIT $ <br /> TOTALFEE S ' TOTALFEE S <br /> FOR OFFICE USE ONLY: neceirr rro. <br /> PE�R SETBACK SIDE SETBALN PLAN CHE K HJI�I�� FEF/J^. ^� m S �� <br /> FRO�SETBACK / =ja (J � � � <br /> � k+P t <br /> USE ZONE LOT AREA <br /> VACANTSITE FEES VALUATION FEE <br /> C`r rjL1�� � JSp ❑ YES f7, NO BUILDING � <br /> NU.OFSiORIES o[[uanNtv Noo�Mrtu��:cuNrts � <br /> 7VPEOFCONSi eAwr pLUMBING ' <br /> SIZE OF BLDG. FIRE SPRINNLERS REO'0 BASEMENT MECHANICAL � <br /> ^ YES C NO ' <br /> NEIGNT LIMITATION ADDITIONAL PLAN CHECK ' <br /> OCCUPANCY LOA� FIRE AURM REO'D � � <br /> �YI1�- o- 25 OTHER � <br /> REnSON STATE BUILDING SURCHARGE O <br /> i <br /> INTANE BY PLANS APP@O�VEO BY CITY OF EVERETT PUBLIG WORKS n '` <br /> �Iv( LOCAL SALES TOTA� � / ,t"J U <br /> onre 7 �3 <br /> TAl(CODE IS 3105 <br />