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APPLICATIQ�I FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRlNT <br /> BUILDING DEPARTMENT � HEATING SYSTEM: i�GAS J ELECTRIC U <br /> 259-8810 <br /> I DEMOLITION i i COMBINATION �BUILDING I ;MECHANICAL I i PLUMBING I i SIGN <br /> IOWNER .` � / M4II.AO�RGE�55 �tIGK, Q�I�rqTY �/ ,(� ZIP (�G PHONE <br /> ��I� Y�11�/1�1k��: lo I r �V �lir� / (JZ Si3- 97�5 <br /> 1EryANi MNL�ODRE55 CITV 21P PHONE <br /> ARCNITECTOPDESIGNER 61NLAODRES$ CI7Y 21P PNONL <br /> S�mF <br /> GENERALCONTRP.CTOR MFILADDRE55 CITV ZIF PNONE STAiEUCENSEv <br /> I.IECHANICAL CON7RAGTOR MAIL ADOItESS CITY ZIP PHONE Si�TE LICENSE• <br /> PLUI.IBiNG COHTpACTOR MAIL AO�RE55 C11Y ZIP PMONE STATE LICENSE� <br /> CONiRAGT PRICE OF WORR <br /> / : � <br /> DESCRIBE WOFK AND SOIIARE FOOT�GE INVOLVED CONi�Gi PERSON�ND PMONE NO <br /> �„�.�P P� t !� /'�� <br /> ( -S`2 � ��) C a /(� /� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APPUCATION AND KNOW THE SAME TO BE 7RUE AND CORRECT.ALL <br /> f,,,i�ht,,,i,�I �- �.� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALOESCRIPTIONOFPROPERTVISNOWN E ORATTACHTWOCOPIESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT o�aK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW AEGULATING CONSTRUCTION OF THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT i AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEI TAX 10 NUMBER CONTRAC 1 C A D WAC. <br /> CONSTRUCTION LOAN LENOER.ADDRESS.TELEPHONE NUMBER �j ^ 7_� , / <br /> O � 7 <br /> PROJECT DR S s' "+ "r o+'� <br /> C�1vflUSYE55LC[16f M1O <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT 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 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 DRA�N HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINIEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT 5 PERMIT S <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FPONT�C; REARSET� � SIDESET�N/ PLANCHECKNUMBE�� FEE� RECEIPTNO <br /> 9s i c <br /> use zor+e l0T AREA VACANT SITE FEES VALUATION FEE <br /> . � [-! YES � . NO BUILDING � � <br /> iVPE�iC 45i NOOFSTOR'ES o[Cu�A�F.v n00fCdF.l":'.r.n5 <br /> 2 °Pcp° PLUMBING <br /> SIZEOFOIDG FIRESPflINNLEB5RE0-D BFSEMENT MECHANICAL <br /> 'Z�}� J.� - � f:� YES i��. NO <br /> OGCUPANCY OAO FIREAI�RhIREOO NEIGHiLIh11T�TION A�DITIONFLPLANCHECK <br /> / <br /> � O OTHER <br /> REA50�1 i <br /> S7ATE BUILDING SURCHARGE j <br /> INi�NE AY PIANSn 3 JED BY CITY OF EVERETT PU�LIC WOfiNS <br /> �. LOCALSALES �� <br /> ppTE� g c� TAX CODE IS 3105 Tora� ;� <br />