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APPLICATIN'V FOR CONSTRUCT"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING CEPARTMENT � HEATING SYSTEM: J GAS �ELECTRIC ] <br /> 259-BB10 1' <br /> , DEMOLITION L' COMBINATION J(i BUILDING I MECHANICAL i_! PLUMBING ; : SIGN <br /> OWNER MAILFDDRE55 LITY ZIP PIIONE <br /> ToHn I� lSP2Cr �03 t Gdd�� E'��" qF1� � a-s9 -3lo a <br /> TEN/NT MAILAODRESS LITY ZIP PMONE <br /> S�E - <br /> ARCIUTECTOFiDESIGNER MAILA�DRESS GTV ZiP PHONE <br /> �... — <br /> GENERALWNTRACTOR MnILADORE55 CITV ��P PMONE STATEUCF_NSE� <br /> .- /�4...n� i <br /> YI� � <br /> MEGNRNICALCONTRNLTJR MAILAUDRESS CITY ZIP PMONE $TAiELICEIlSE• <br /> ���� � � <br /> PWMBING CONTRRCTOR / MAIL n00RE55 CITV 21P PHONE STATE LICENSE• <br /> � �J�C <br /> CONTRACT PPICE OF WORK <br /> GG� <br /> DESCRIBE WORK AND SOIIRFE FOOTAGE INVOLVE� GONTAGT PERSON AND PMONE NO. <br /> N/ Ir SC� CT S <br /> 51u6tY l^�/A/ A /S � C.OAJL SPAClc M Pos f f <br /> /� 7[.a!'� v+✓�h <br /> .f.,�o/i + p�;t�n,,. t/n /�2..J (�Mu-S vnoE� <br /> � �ci rin�r v� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOf BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S�n�� �,,,,..�/y / �✓ unCih/y/C-� UT PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEWLDESCRIPT10NOFPROPERTV�SHOWNBELOWORATTACMTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br /> �or etocK oF AUTHORITY TO VIOLATE OR CANCE:. THE PROVISIONS OP ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEhrORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRCEL TA%ID.NUMBER CONTRACTOflS LAW 18.27 RCW AND 296.200 WAC. <br /> � OS - - DO - OvO�'/ I <br /> CONSTRUCTION LOAN LENDER.AOORE55,TELEPNONE NUMBER I <br /> � ,�. �� 6-, -gy � <br /> PROJECT ADDRESS sicH�mne o„c <br /> � � � CITVOUSMCSSUCCNSENO <br /> PLUMBING MECHANICAI <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EGUIPMENT FEE <br /> WATER CIOSET�TOILET) � �+/C—A/HNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER WOODSTOVE � � <br /> URINAL ; METAL FiREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> flOOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETC.) I <br /> � � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL S <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBAC� REAR SETBACN' SIDE SETBACK / PLAN LNECK N�LR/ F[E � qO • R�/��� <br /> j. � � L <br /> usezon! � LOTAREA VACANTSITE FEES VALUATION FEE <br /> G YES u NO BUiLoirvG z,jZ� � <br /> � � <br /> lvP OFCONSi. NO.OFSTORIES octu��rp NodmvuuN6uNrt5 <br /> i <br /> _� � ���� , PLUMBING � <br /> i <br /> SIZEOFBLOG FIRESPRINKLEPSREO'D BASEMENT / MECHANICAL <br /> �.j N� �. : YES .vN� � <br /> OCWPAYCYLOAO FIREALMMR[OD HEIGMTLIMITATIO% <br /> ADDI710NAL PLAN CHECK ; <br /> �N J OTHEIi � <br /> REASON � <br /> STATE 6UILDING SURCHARGE <br /> INTAKE DY PLANS APPROVEO BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES - <br /> oAre TA%CODE IS 3705 TOTAL �Z ��� <br />