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A�PLICATIC'1 FOR CONSTRUCT'9N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SVSTEM• ❑GAS �]ELECTRIC ❑ <br /> BUIIDING DEPARTMENT <br /> 259-8P10 <br /> ❑ PiEMOLITION ❑ COMBINATION �BUILDING I-1 MECHANICAL ❑PLUMBING ❑ SIGN <br /> py,ry�q MARADDRES$ CITV ZIP PMONE <br /> UAr/�o �vucA,� a�io �Ew��f �� Q�ao/ as�-a�as <br /> TENANI / MAIL ADDPE55 GITV ZIP PMONE <br /> /��� ��{��Ij (�r,496 �P cr� �7/0 /fE1� �i,�� �5�� ,�•59'-a6aS <br /> ARCMITEfjT HDESIGNER MAILADDRE55 LITY ZIP PHONE <br /> .. �AE/ � �a9 �c� ��»�iis� 9�6a9'o .56� -Sy�s _ _ <br /> GENER 1 �ONTRACTOR MAILIIOURESS CIry ZIP PMONE STATELIfENSE� <br /> ��o�� /�kY��c4 !�9' F� S,GMAI�� �fD 5�3s-9's!� .��✓.��066 Cl�� <br /> MECH IC�L CONTMCTOR M��l ADORE55 CITY ZIP PHONE SiA1E LICENSE• <br /> PLUMBMGCONTR�CTOR MMLAODNE55 QTV ZIP PHONE STATELICENSC� <br /> � CON T PRICE OF WORu ' <br /> . <br /> 5- <br /> OESCRIBE WOAK�ND SOU�NE FOOT�GE INVO�VED CONTACT PERSON AND PHONE NO. <br /> ' uu„�� .z . <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> . praroseouse oF euaomc � APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � (� S �E CL-C PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYFE OF . <br /> �EG�LpE$GqIp71pNOFPROPERTYISMOMTIBELOWOR�iTACHTWOCOPIE51 WORK WILL BE COMPL`TED WITH WHETHER SPECIFIED HEHEIN OR <br /> NOT. THE ORANTING UF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �ot 6 e�xK� � �—�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> i � �THER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> PERFOP'utANCE OF CONSTRUCTION.THAT I AM AUTHOR�ZED BY THE <br /> � � 6 _ ��� _ �6 �G�� OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> qPPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � PARCEL TIU(I.U.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ' �.�� o; ,�s/� <br /> . { GONSTRVGTIONLOANLENDER•/�DD�ESS,T�LEPlIONENUMBEP <br /> IPROJECT ADDRE s �runc <br /> cmeusmcssicEr�sEra <br /> i oZ. O Etd rIECHArNCAI <br /> PLIIMMNfi FEE <br /> � N0. TYPE OF RXTIME OR ITEM FEE N0. TYPE OF EGWPMENT <br /> WATER CLOSET(TOILEII � � NC—NHNDLG UNITS—H.P. ' <br /> BATHTUB ' FORCED AIR SYST�MS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BAS:N) � UNIT HEATERS—B.�.U. M ' <br /> , SHOWER � CLOTHESDRYERS � <br /> � KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RAN6E HOOD ' <br /> � LAUNDRYTRAY ; WATER HEATER � <br /> , CLOTMES WASHER � WOOD STOVE <br /> � URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> I DRINKING FOUNTAIN � FIREPUCE INSERT � ' <br /> � FLOOR DRAIN � HEAT PUMP � <br /> i ' GAS PIPING ' <br /> BACKFLOW PREVENtERS � , <br /> i ROOF DRAINS--RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � ; <br /> � <br /> , <br /> � <br /> � <br /> ' SUB TOTAL S ' SUB TOTAL S � <br /> � PERMIT S � PERMIT S ' <br /> � TOTALFEE E ' TOTAI FEE S ' <br /> FOR OFFlCE USE ONLY: neceirrrw <br /> FRONTSEiBACK REARSCT&1CK SIDESETBACK PIANCH CKNUMBER FEE� �S �/]� <br /> ; �39s� a � <br /> �� v��u�na+ �E <br /> USE ZONE LOT�REA V�CANi SITE ^ � <br /> ❑ YES ❑ NO BUILDING L� � <br /> i <br /> lYPEOFCONT NO.OFSTORIES ottua�Nn NOo'vMluMGuxiiS � <br /> ceao pLUMBING ' <br /> SIZE OF BLDG. FIRE SPHINKLEPS REO'D BASEMENT MECHANICAL 1 <br /> ❑ YES n No � <br /> ADDITION�L PLAN CHECK ' <br /> OLCUPANCV�OAD FIREAURMREOD HEIGHTLIMITATION i <br /> OTHER 1 <br /> REnSON STATE Bl11LDING SURCHARGE ' <br /> INTAI(E BY PLANS�P�ED BY CITY OF EVERETT PUBLIC WORNS � <br /> �� LOCAL S11LES �� <br /> %� N TAX CODE IS 9105 roT�� <br /> D�TE + 1 ��� <br />