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APPLICATIO. . FOR CONSTRUCTI N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ;Q GAS J ELECTRIC J —1 <br /> 259-8810 � <br /> DEMOLITION I i COMBINATION L I BUILDING �MECHANICAL ;/PLUMBING ' ! SIGN <br /> OWNER M�ILAD�RESS CITY ZIP PMONE <br /> �,�/a�c%/s� /��/ac�jlZ�T ���,Q �,rr�o� �q r� �,1��F7 C�.�� <br /> TCNANi hIML ADDRESS CIiY ZiP PNONE <br /> ARCHI ECTOfl0E51GNEN MNLAOORESS CRV ZIP PHONE <br /> ��,a,��.,�A��---?��� %-%���ZY�� �'� ��i�' �'�-�/T�� �(���<�/��z <br /> CENERALCONTRACTOR IdAILAUUR SS CITV ZIP PNONE STATELICENSEs <br /> MECM�NICALCONiRACTOR MNLAD�RE55 CRY ZIP PMONE ST�TELICENSE• <br /> PL11�.1BINGCONiRACTOR � h141l�DDRE��Oa '�`�n/ !��C��IT�Y �� ZI� � PHO� TATELICENSEA <br /> �V dU /�/���.t� !�r_.� ��� �'-�' 1 � � /�/D��� <br /> CCNTR�CT PRICE OF 1 RN , <br /> � 7�C1�` <br /> �,ES9 RIPF W09K AND SOUAPE F TpGE INVOlVEO CON CT P PSON AND PHO E N Z z �/i1 <br /> ;�VS���J/1�ly � � ac/� �' <br /> �_ � , U .� �G / <br /> � � w <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TFIIS <br /> PRGPOSEDUSEOFOUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> L6G4LOESCRIPTIONOFPROPERTY�SHOYlNBELOWORATTAGMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iot BLOCN NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> oF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.TH I AUTHORIZED BY THE <br /> OWNER OF IS P PERTV TO PE OR HE RK FOR WHICH <br /> PARLELTA%IDNUMBR p APPLICA 10 CO LY H THE STATE <br /> y���DD?(��/XJO U� CONTRACT L 1 .27 RC D 2 00 <br /> CONSTRUCTIONLOANlENOER,FDDRESS.TELEPHONE NUTABER � <br /> PROJECT ADDRESS .,r�mm�E o�,� <br /> � <br /> ci.rnusin[ss c rv� � �- <br /> PL MBING MECHANI L <br /> NO. TVPE OF FIXTURE 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 � CLOTHESDRYERS <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 /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAI'PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS--RAINLEADERS � ExHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br /> � <br /> � <br /> , —T <br /> SUB TOTAL S ; SUB TOTAL 5 '�— <br /> PERMIT S PERMIT 5 � � <br /> TOTALFEE S TOTALFEE $ .�� � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACN REARSET84CK SIOESE7BACK PLANCHECKNUMBEF FEE RECFIPTNO. <br /> � �� U <br /> usezoNe �oraaen VACANLSIiE FEES VALUATION FF.E <br /> 'l� YES C NO BUiLDIN., ' <br /> ivPE OF LONSi. NO.OF STORiES a[cuvn� � <br /> �Cv FpO�pWELLi1;6U4i15 <br /> taou� pLUMBING � <br /> SIZE OF BLDG. fINE SPRINNLERS REO'D B�SEMENT MECHANICAL <br /> '"�: YES •.^1 NO <br /> OCCUPANCY LOAD FIRE AL�PM REOD HEIGNT LIh11TAilON �+DDITIONAL PLAN CHECK i <br /> OTHER i <br /> �iEA50N <br /> STATE BUILDING SURCHARGE <br /> INir1NE�Y PLANS�PPROVEpOV CITY OF EVERETT PUBLIC WORNS � <br /> LOCALSALES ' <br /> onm TAX CODE IS 3105 TOTAL ; <br />