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APPLICATIC��] FOR CONSTRUCT�IN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEAT�NG SYSTEM: � GAS i]ELECTRIC ;J <br /> BUILDING DEpARTMENT <br /> 259-8810 <br /> DEMOLITION i l COMBINATION ✓BUILDING I I MECHANICAL f ! PLUMBING I 1 SIGN <br /> OWNER �j MAIL A��RESS CITY ZIP PHONE <br /> �� WKl/f.� h rnQ�}�/rC 5530 �N,L'Ct/7Fo✓�.V FUE.C'f%?�.tJn 9�'.703 0�90-�/7L <br /> TENANT h1AILAUDFE55 CITY 21P PHONE <br /> 4RCNITECT OR OESIGNER lAAIL F��RESS CITV ZIP PMONE <br /> GENEHALCONiP�CTOR M+1ILADDRE55 qTV 71P PHONE STATELICENSEY <br /> MECNRNICAL CONTRFCTOR M11AIL ADDRE55 CRY ZIP PHONE STATE UC[NSE• <br /> PLUMBING CONTRACTOF MAIL ADORE55 CITY ZIP PMONE SiATE I.ICENSE N <br /> CONTRACT PRICE OF WORK � <br /> UESCRIBE WORN AND SOUAFE FOOTAGE INVOLVED WNTACT PEFSON ANO PHONE N0. <br /> cu 4. rwrov.� o2Gb- 5� <br /> E e W F rro J�� 5' � 6'-9'� � /f10rr/-ro�rii <br /> � ' yAL S MAX PI-�-OWrt-O I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPiIONOFPROPERTVISNOWN6ELOWORATTACHM'OCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot a�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofl THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARGEI TAX ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSiRUGTIONLOANLENDEfl.ADDRE55.TELEPNONE NUMBER <br /> X �� .��1 w .TucY � /9yY <br /> PROJECT ADDRESS sic�.iune �"'E <br /> S3c� P��VI `./,h1E cnreusmEssiicrNsrr�a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—A/HNDLG 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&DISP � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ' WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE�:JSi 7T <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUS7 FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � ' <br /> � ' <br /> SUB TOTAL 5 '; SUB TOTAL $ '' <br /> PERMIT S PERMIT 5 � <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBAGK SI�E SETBACK PLAN LHECK �BEN FEE RECEIPT NO. <br /> 1 D <br /> USE 2�NE LOT AREA VAC�NT SITE FEES VALUATION FEE <br /> Il VES ._1 NO BUILDING �SD I ' <br /> IYPE 0�CONSi. NO.OF STOPIES o[tuo�yn xo o�nxuuxf ums � <br /> sAour PLUMBING <br /> SIZEOFBLOG. FlRESPRINKLEPSREO'D BASEMENT MECHANICAL <br /> ❑ YES NO <br /> OCCUP�NGYIOAD FIRE�L�FMREOD HE�GHiUMITF710N ADDITIONALPLANCHECK � <br /> i <br /> i <br /> OTHER <br /> REASON � <br /> STATE BUILDING SURCHARGE �D <br /> INTANE 9Y PLAN�ROVEDBY CIT/OF EVERETT PUBLIC WORKS i <br /> LOCAL SALES <br /> on.E-7 � TAX CODE IS 3105 TOTAL ' <br />