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APPLICATIQ^� FOR CONSTRUCTr'1N PERMIT � <br /> �) � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 0 <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC J <br /> 259-8810 <br /> DEMOLIT(UN ! COMBINATION i l BUILDING I MECHANIC�;L 1�LUMBING � SIGN <br /> ��EA MAIL AUURESS CITV ZIP PHONE <br /> f=/'.I��r.tr��'L-�n,� /,l.��8 � 1,.s��r��y�,�� 6S�-fi i 2 <br /> �r���T MaILA0DRE55 ��ry Z�P <br /> PMONE <br /> AFCHITELTOFDESIGNER MAILAD�RE55 CITY 21P PHONE <br /> Gd�v �#'d,., s�u ��/.2 a1dV .-v� ;rz� y�4�7o/ �5,2 � �s3 <br /> GENERAL NTR�CTOR MAILADORC55 � CITY ZIP PHONE STATELICENSE� <br /> fLf.9C..��'faret .��v�;t� ���>a-Y�.�l'92 < < i� <br /> MEGHANiCALCINJTRACTOP MAILAOORESS CITY ZIP PHONE <br /> STATE LICENSE� <br /> PLUTABING C NTRSCTOR MRIL FpDRESS dTY ZIP PMONEO SiATE LICENSE t <br /> ��R�P, N 3d' S��v�.S�,c-t� .r� � !��. ,.� � <br /> o�� <br /> DESCRIBE WORK FND SOUARE POOTAGE INVOI.VEO CONTFCT PERSON ANO PHONE N0. <br /> PROPOSEOUSEOfBUILDMG I HEREBY CERTIFY THAT I HAVE REAO AND EXAM�NEO THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> PROVISIONS GF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPPOPERTV�SHOWNBELOW09ATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �o- eicxK oF NOT. THE GRANTING OF A ^ERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY 70 VIOLATE OA CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE <br /> OWNER GF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH <br /> PARLEI.Tq%ID.NUMBEF APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENDER.pDDFE55.TELEPHONE NUMBEF ](J-=-Jee�-�%�L!X ��/ <br /> PR ECTADDRESS sa uae ��' ^ �� <br /> O I — oat <br /> Cliv BU91Nf55 tiG[NSE NO <br /> PLUMBING MECHANICAL <br /> NO• TYPE OF FlKTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> � WATER CLOSET(7011ET) A�C—A'HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BAS!N) � UNI7 HEATERS—B.T.U. M <br /> _ SHOWER � CLOTHES DRVERS <br /> _ KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> !.AUNDRV TRAY ; WATER HEATER <br /> CLOTHES WAgHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN I FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP —� <br /> _ BACKFLOW PAEVENTERS ' GAS PIPING <br /> ROOF DRAINS—RAINIEADERS EXHAUST FAN � <br /> SINK(SEFVICE—BAR,ETC.) � � <br /> � <br /> � , <br /> � — <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ ;� PERMIT $ <br /> TOTAL FEE $ TOTAL F[E $ <br /> FOR OFFICE USE ONLY: <br /> FHONT SETBACK REAR SETBACK SIDE SETBACK PLqN GHECN NUMBER f[E RECEIPT NO. <br /> USE IONE LOT�PEA VACANT SITE PEES VALUATION FEE <br /> '� YES ��:�- NO BUi�OMG <br /> TYPEOfCOHSi NO-0FSTORIES atueaN[v xoO�owTwti5UNrt5 <br /> G900� <br /> PLUMBING <br /> 51ZE OF 9lDG. FIRE SPRINK�ERS REO'D BASEMENT <br /> � : YES . NO MECHANICAL <br /> OCCUPANCY LOqO FIAE�LAPM REOD HEIGHT LIMIiATION �DDITIONA�PLAN CHECK <br /> REnSON OTHER <br /> —T <br /> STATE BUILDING SURCHARGE <br /> INIANE BV PLANSAPPROVED BY CITY OF EVERETT PUBLIC WOqKS <br /> LOCAL SALES <br /> onre TAX CODE IS 3705 Tota� <br />