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APPLICATIQ—� FOR CONSTRUCT'`lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS i]ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION fC� COMBINATION I I BUILDING ❑ MECHANICAL ❑PLUMBING 1=1 SIGN <br /> OWNEfl IAAILADDFE55 CITY 21P PHONE <br /> l`1.T1 L �(J0�( �� , Y�C ��i '� r t.K�M4"� 11�bJ ,�j��'SZ. .$S3 ' :3S�7� <br /> TENANT ~ MFILADOPE>S GITY ZIP PNONE <br /> ARCHITECTORDESIG�:ER MAILADDi1E55 CITV ZIP PHONE <br /> � !{� �i9Y�'�`L <br /> GENERAL CONTFACTOR MFIL ADDRESS CITV 21P PHONE STATE LICENSE� <br /> MECHANICAL CONTRACTOR MAIL ADDFES` CITY ZIP PMONE STATE LICENSE r <br /> PLUMBING CONTRACTOR MAIL ADDRE55 CITY ZIP PHONE STATE LICENSE� <br /> CONTRACT PPIGE Of WORN _� <br /> 3_� <br /> DESCF�BE WORN AND SOUARE FOO AGE INVOLVEI CONTACT PEBSON AND PHONE NO. <br /> � 7 COr 1WY21 � — <br /> P-�,•�- k' _ <br /> N4.�r �Dilt� � i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Q�_�i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPFOPERTVISHO".NdELOWORATTACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or 3 �'' ou�cK 3 — oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��Y� y �Y��„��-� D� 1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BY THE <br /> OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAF:,E:`^"�A.NUMBF.R CONTRACTORS LAW 1827 RCW AND 296.200 WAC. . <br /> G.)NSTRUCTIOi LOAN LENDEfl.PDDRE S.TEIEPHONE NIIMBEP <br /> .�i � c� X lrL �� ���i-9� <br /> S�GNAIUA[ pAIE <br /> ::CT AD RESS <br /> Citv BU.�NESSUCENS[NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � lUC—A4INDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—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 tIEATER � <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT __� <br /> FLOOR DHAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—FlAINLEAJERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR.E�.C.) � <br /> � <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL 5 <br /> PERMIT S PERMIT 5 � <br /> TOTAL FEE 5 TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB4LN REARSETBALN SIDESEi�ACK PLANCNECRtfIjJfB,E� FEE REGEIPTNO. <br /> i/./(i/_ <br /> �fJ OlL' W <br /> USE20NE �ornaen �ACANTS�TE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUiLDiNG D/(� S � �v <br /> 7VPC OF C0�15i. NO OF STOFIES a[ur4�.n N9 OroW[u�v;uM1its ' <br /> i <br /> �PpLP PLU1dBING � <br /> i <br /> SREOFBIW. FIRESPFINKlERSREOD BASEMENT MFCNANICAL � <br /> �.- YES � � NO --- ' <br /> OGCUPANCY LOAD FlRE A�AHM REOD HEIGNI LIl.II7AilON ADD1110NAL PLAN CHECN � <br /> i <br /> OTHER � <br /> REASON ��� <br /> ' STATE BUILDING SURCHAF7GE <br /> IN7ANE�Y PLP.NSAPPROVEPOV CITY OF EVERETT PUBLIC WORKS � <br /> LOCALSALES <br /> onTe ��' TAX CODE IS 3105 TOTAL <br />