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APPLICATIO�- ` FOR C�DNSTRUCT�"`N PERMIT ��" <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT IIEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> i ] DEMOLITION f I COMBINATION I_i BUILDING XMECHANICAL � 1 PLUMBING �l SIGN <br /> OWNER MAILADDRESS CITY 21P oqONE <br /> J,M r,-�c�. �t�o� /1or-lar��U �vcrGt!-/�a 98'�L_-�,��- 7505 <br /> 7ENANT MA'LADDPESS GTY 21P PHONE <br /> APCNITECTORDESIGNEfl MAILAp�FESS C17Y ZIP PHONE <br /> GENERAL CONTR4CTOfl MAIL ADDRE55 CITV 21P PMONE STATE LICENSE R <br /> MECHANICAL CONiRACTOR MAIL qG�qESS C�TV ZIP PHONE STATE IiCENSE a <br /> .�u'�ieu�E(Pa-fi.�G /2a2 Chestnccl' !�F� �ue.rc� u.� 9� vi 3 33 yS� S c4 V i h o 9 0 <br /> PLUMBING LONTRAGTOR f MAIL AO�RE55 CITV ZIP PHONE STATE IICENSE� <br /> WNTRnCT PRICE OF\YORN <br /> �� <br /> DESf,RIBE WJPK ANO SOUARE FOOIAGE INVOLV[U CONTAC7 PEPSON�ND PNONE NO <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USE OFBWLDWG APPLICA�ION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEG4LD[SCiiIPT1pNOFPROPERTV�$NOWNBELOWORPTfACMTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AIITHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LGCAL LAW REGULATING CONSTFUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BV THE <br /> �� � OWNER OF THIS PROPERTY TO PERPORM THE WORK FOR WHICH <br /> PARCELiAXIO.NUMOER APPLICATION IS MADE ANC I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> COYSTqUCTI0Nl0ANLENDER.ADORE55.TElEPHONENUMBER <br /> PROJECT ADDRESS S,cN.��—���t "` =7 "�'=�=�—'�•-�'��h��� <br /> � c <br /> � g���- �,r.e�=,�«S���v=��o — <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FO(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A�HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH OASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; \'ENTILATION FAN <br /> DISHWASHER RANGE HOOD � � <br /> � <br /> LAL'NDRY TRAY ' / WATER HEATER � <br /> CLOTHES WASHER _ �— WOODSTOVE <br /> URINAL ; METAL FIREPLACE(WOCD BURNING) �— <br /> DRINKING FOUN7AIN ; FIREPLACE INSERT <br /> _ FLOOR DRAIN � HEAT PUMP . <br /> _ BACKFLOW PREVENTEFS GAS PIPING � <br /> ROOF DHAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> --T <br /> I i <br /> T <br /> 1 <br /> I <br /> SUB TOT�L $ ' SUB TOTAL 5 <br /> _ PERMIT S PERMIT 5 <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFIG_ USE ONLY: <br /> � FRONTSETBACK REARSETBACK SI�ESETBAGK PLANCN:CKIJUn10ER FEE RECEIPTNO. <br /> � /i� <br /> use zoNe LOT qREA vncnNr sre FEES VALUATION FEE <br /> !J YES ❑ NO BUILDING <br /> 7YPEOFGONSi. NO.OFSTOFIES ttcu>�uv FoorOxiwHGm�.ts _ <br /> eaoue pLUMBING <br /> SIZ[OFOLOG. FlRESPRINKLERSREO'D BASEMENT MECNANICAL <br /> ❑ VES ❑ NO <br /> OCCUPANCYLOAD FlM�ALARMREOD HEIGHTLIM1IITATION �D�ITIONALPLANCHECK <br /> qenSON OTHER <br /> STAT[BUILDING SURCH�FGE <br /> INTANE BV PLANSAPPROVED 9Y CITY OF EVERETT PUBLIC WORNS <br /> LOCAL SALES <br /> onTe TAX CODE IS 3105 TOTAL <br />