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APPLICATIQ`�1 FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ ELECTRIC �] <br /> 259-8810 .: <br /> I I DEMOLITION i COMBINATION i BUILDING �(MECHANIC.AL i PLUMBING i SIGN <br /> OWNER 1AILADDRE55 CITV 21P aHONE <br /> 1`�!A me.�D <br /> c o��� � �5.�.5 i',/n.�ro,� ,4d� 98zo/ s9-S9�'� <br /> TcNANT M4ILADDRESS CITY ZIP PNONE <br /> �RGHITECTORDESIGNER M„'�ppOFE55 GTV IIP PHONE <br /> GEkER�LLONTR�CTOR MAILqDORE55 CITY ZIP PHONE STATELICENSEd <br /> MEL/HANIC4LCONTRACTOR A!AILAODRE55 CITY ZIP PNONE STATELICENSE� <br /> ` l 1 � <br /> PLUMDING CONTPACiOP MAIL��ORESS GTV Z'�P PMONE STATE UCENSE A <br /> COiJTRpCT PFICE OF WOflK <br /> a_. Z�i, �y <br /> DESC9IBE lYORH AND SOUAHE FOOT�GE INVOLVED GO 7ACT PEFSON ANO PHONE NO <br /> �- � —�' Ex .a 25�'/-8�87 <br /> /v.4Tt/�/JG ��J �. /�o� au�r�_ <br /> /'�/10 �C�CT2/G — .q I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI".ALL <br /> PROVISIUNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEFTY�SHOWNBELOWORAITAGIITWOCOPIE51 WORK WILI BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> tor BLIX:K oF 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 RC�ULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I D.NUMBEP CONTRACTORS LAW iB.27 RCW AND 296200 WAC. <br /> CONSiRUCTIONIOANLENDER.ADDRE55.TELEPHONENUMBER <br /> � y,�� <br /> PROJECT ADDRESS sicr�—o��� o�rE 7����9S <br /> Jr d.e_ 07E.7o( .. <br /> LI1V OUSME55 LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FDCTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC—A/HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U/aoM 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 � WOOD STOVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT . � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; 3 GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SEflVICE—BAR,ETC.) <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL 3 �7 ; <br /> PERMIT $ PERMIT $ ; <br /> TOTAL FEE S ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SEiBACK REAR SETBACN SIDE SETBRCK PLAN CHECN Ny�.10ER FEE RECEIPi N0. <br /> !/r.J') <br /> usezoNe LOTAREA VACANTSITE FEES VALUATION FEE <br /> G YES ❑ NO BUILDING <br /> iYPEOFCONST NOAFSTORIES acuo�NCr NoaOw[luNGuxrts <br /> °a0°v pLUMBING � <br /> S�ZEOFBLDG. FIRESPRINKLERSREO'D BaSEMENT ��EGHANICAI � <br /> f YES i� NO <br /> OCCUPANCYLOAD FIRE�LAqhIREOU HEIGHTUKIipTION ADDITIONALPLANCHECK � <br /> OTHER i <br /> RE�SON <br /> STATE BUILDING SURCHARGE i <br /> INiAKE�V PLANS�PPROVEO BY CITY OF EVERETT PUBUC WORKS <br /> LOCALSALES ' <br /> onre TAX CODE IS 3105 rorn� <br />