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MIT <br />TO BE �, MPLETED IN Bi.ACK INK—PLEASE PRL. �' <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION f� BUILDING �MECHANICAL �PLUMBING ❑ SIGN <br />015RJER MAILADDflE55 �1 CI,T�Yf G��ZIyP PHONE <br />� , ./ ��Q' �A _ LLLlA1.1T 76ow� a�-9aaa <br />TENANT MAILADDRE 3 CITY ZIP PHONE <br />ARCHITECTORDESIGNER MAILADDRESS LITV ZIP PHONE <br />GENERRtL'CON^TRACTOF MAILADDRE55 CITY ZIP PMONE SiATEL�CENSE/ <br />� I I�C 0. <br />.___..._.._.."_ .............. m,,,�,,,,,,,,wa cITY ZIP PHONE STATELICENSE� <br />PLUMBINGCONTRACTOF MAI�ADDRE55 pTY ZIP PHONE STATELICENSE� <br />CONTR�CT PRICE OP WDflK <br />LOT <br />USE OF BUILDING <br />OF PNOPEflTV (SHOWN BELOW OR ATTACH <br />- BIOCK OF <br />PARCELTA%I.D.NUMBER <br />CONSTRUCTIONLOANLENDER.AO�RESS,TELEPMONENUMBER <br />PROJECTADDRESS �� <br />%`�0 / �'o�ci� <br />PLUM9�NG�- <br />NO. TYPE OF FO(TURE OR ITEM <br />oi WATER CLOSET (TOILEn <br />BATHTUB <br />`� LAVATORY (WASH BAS�N) <br />SHOWER <br />KITCHEN SINK 8 D�S' � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />� SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK SI�E <br />USE ZONE <br />TVPE Of CONSi. <br />SIZE OF OLOG <br />OCCUPANCVL <br />PEASpN <br />INTAI(E �Y <br />No.OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIRE AIARM flE0'D <br />PUNS APPPOVED BV <br />OATE <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THA'f I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMF TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PRGPERTY TO F ERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 'B27 RCW AND 296200 WAC. <br />x ��� �(a3(�3 <br />swrv�rune o�tc <br />i rre �r tuuirixenT FEE <br />A/C--A/HN�LG UNITS—H.P. , <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M —1 <br />CLOTHES DRYERS �- <br />VENTILATION FAN -� <br />RANGE HOOD �— <br />WATER HEATER . <br />YlOOD STOVE ; <br />METAL FIREPLACE 1WOon auatiwr: —�--T— <br />FIREPLACE INSERT <br />HEATPUMP <br />EXHAUST FAN <br />VRCRNT SITE FEES <br />❑ YES ❑ NO BUILDING <br />aaur.x:r xo.momuixcuxns <br />er,ao pLUMBING <br />BnSEMENi MECHANICAL <br />❑ YES ❑ NO <br />HEIGH7liMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />FEE � RECEIPT <br />G <br />� <br />