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APPLICATIC ] FOR CONSTRUCT. )N PERMIT � <br /> TG BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM:�GAS ❑ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL �PLUMBING I� SIGN <br /> OWNER MqILAUDRE55 CITV ZIP PHONE <br /> �lA-n.1�rJ Ta�n�Sr�li� t���l c�a��i ��� �.r- -rr �I47���� <br /> TE NT MAILADDRE55 CITV 21P PHONE <br /> ! <br /> _�i�1 a n1 �n.,�n> >f i`! i� -���_(_C, �.c 9��G�: �7r �i X�v( <br /> ARCHIIECTORDE5IGNER MAILADDRE55 CITY IIP PHONE <br /> GE ERAICONTRACTOR MAILADDRESS CITY IIP PHONE STATELICENSEI <br /> � - :_ �A��� �-��r� �Itb���D`�k� kA 9�I�� ::sZ.�- v ���� o�TNa�hllo7P-� <br /> ECHr1NICAL CONTR�CTOR MAIL pDDRESS CITY I�p PHONE STATE UCENSE� <br /> `�f��'lC. <br /> PLUMBINGCONTRACTOR MAILAD�RE55 CIiY IIP PHONE STATELICENSEo <br /> CONTPACT PRICE OF WOR <br /> ��'� '�v G _ <br /> DESCRIBE WORK AND SOLARE FOOTAGE INVOLVED � CONTACT PEflSON ANO PHONE NO._ _� <br /> C: \ <br /> V <br /> �� �� A 3�zz - RI <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCHIPTIONOFPROPERTY�SNOWNBELOWOflATfACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or B�ocK aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STAT LAW REGU CONSTRUCTION OR THE <br /> PERFO CE STRUCTI . TH I AM ORIZED BY THE <br /> OWN OF THI PE PERF RM ORK FOR WHICH <br /> PARCELTA%I.D NUMBER APP ICATIO E I O W�TH THE STATE <br /> �s � � _ CON A 1827 2 . <br /> CONSTRUCTIONLOANLENDER.RDDRESS,TELEPHONENUMBER // / � � <br /> PR0.IECT ADDRESS. e� �1 sn,,,,,,,�E o�r� <br /> n �n� r ` � arraus� xse <br /> PLUMB NG MECH ICAL <br /> NO. TYPE OF FDfTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—lvHNDLG UNITS--H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. 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 /> LAUNDRYTRAY ' WATERHEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' h!ETAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTA�N � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; � GAS PIPING � � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ET(;.) � <br /> � � <br /> � <br /> � <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ ' / <br /> TOTAL FEE $ ' TOTAL FEE $ � / <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCK REARSETBRCK SIOEScTBACK PLqNG F.CKN B�$� FEE RECEIPTNO. <br /> l�o�� <br /> USEZONE LOTOREA VRCANTSITE PEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING <br /> i <br /> i <br /> 11'PEOfLONST. NO.OFSTORIES o.:NccNtr N001o1YFLLiNtuvnS <br /> euouP p�UMBING � <br /> SIZE OF BLDG. FIRE SPRINK�ERS REO'D BASEMEIJT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPRNCY LOAD flqE ALAfIM flEOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> REASON OTHER i <br /> STAiE BUILDING SURCHARGE ; <br /> INTFKE BY PLANS APPqOVED 0V CITY OF EVERETT pUBLIC WORKS � <br /> LOCALSALES ' <br /> DAtE TAX CODE IS 31 OS TOTAL <br />