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APPLICATIQr�' FOR CONSTRUCT�"�N PERMIT � <br /> Tn BE COMPLETED IN BLACK INK–PLEASE PRINT <br /> HEATING SYSTEM: �GAS J ELECTRIC r I <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I ' DEMOLITION ! I COMBINATION i BUILDING >CMECHANICAL f ' PLUMBING f i SIGN <br /> � NER NAILADDRE55 CITV ZIP PNONE <br /> S7/� � �� T�/ SC�/-J7Tlf �`oi ,S�` ._j'+�- � `�/ 7 <br /> i nN MAILADDRE55 �Y����I PHONE_�� _���� <br /> Z <br /> ARCHITECTOR�ESI MAILAUOflESS CITV ZIP PMONE <br /> GGNERf.L CONTRACTOR IAAIL ADOPESS CITV ZIP PMONE STATE LIGENSE y <br /> ldECMANICALCONTPACTJR MAILADDRE55 CITY ZIP PHONE STA7ELICENSE• <br /> ������ � G�a� 5� ��;�� ('_P�� <br /> PLIIMBINGG NIPACTOR MML�ODRBSS CIN ZIP PNONE STFTELICENSE� <br /> LONTRACT PRICE OF W ORN <br /> ,� r'j� i.�cl <br /> J �� <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOlVEO CONTACT PER50Y AND PNONG N0. <br /> �/'�.� �V��� r✓�v✓/JC� �4f_�l/JCi�/i�.Ji '" <br /> ���5 , _ I HEREBY CERTIFY THAT I HAVE READ AND EXA'�INED THIS <br /> PROPOSEDUSEOFdURDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF Lf,WS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPFRTV�SMOWNBEIOWORATTACHTYOCOP1E51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P4RGEL TA%10.NUMBER CONIAACTOR�LAW 18.27 RCW AND 296.200 WAC. <br /> GONSTFUCTIONLOANIENDER,ADDRESS,TELEPNONE NIIMBGR GE/� <br /> i I�— �(j -/'I_�. <br /> s.. une ' oeiE <br /> PROJECT ADDRESS � G Z E 70 L• - <br /> !�/ /�IA�`` �V S��� CiivqUSiN[SS�CENS[NO <br /> v — <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—AiHNDLG UNi?S—H.P. <br /> BATHTUB ' FORCEDAIRSYSfEMS—B.T.U�M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHESORYERS ' _ <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> �T <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ' WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR ORAIN HEAT PUMP _ ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL 5 'O ' ' <br /> PERMIT 5 PERMIT S / � <br /> TOTAL FEE S <br /> � TOTAL FEE 5 .S ' � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETOACK RE�R SETB�CK $IDE SETBACK PLAN CNE H NU BER ^ FEE REGEIPT NO. <br /> lv `�• <br /> use zor+e LOT�REA vnenrvT sire FEES VALUATION FEE <br /> �-', YES L� NO BUILOING ' <br /> TYPEOFCONSi. NO.OFSTONIES ocGu>'•cr No01�wEwNcuNnS <br /> cuour PLUMBING <br /> SIZEOFOLDG. FlRESPRINK�ERSREO'D BASEMENT MECHANICAL _J � ' <br /> -] YES !�1 NO � <br /> OCCl1PANCVL040 FlFE�L4RMREO'0 MEIGMTIIMITATION ADDITIONALPIANCHECK � <br /> OTHER i <br /> ---T— <br /> RE�SON � <br /> STATE BUILDING SURCHARGE � <br /> i <br /> INTAKE BV PLANS APPROV[D OY CITY OF EVERETT PUBLIC\NORKS <br /> LOCAI SALES � <br /> ��,E TAX COOE IS 3105 TOTAL ' <br />