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APPLICATIC-1 F�R CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GnS ]ELECTRIC J <br /> 259-8810 <br /> SLDEMOUTION I COMBINATION Bl11LDING MECHANICAL PLUMBING I J SIGN <br /> \VNER IAMLADDPESS CITV ZIP PIIONE <br /> i� c►�►.�-11r_� n3 e. M��,1�a+►� �r Skzo y 3S��S�2� <br /> TENANT MAILADpRE55 UTV ZiP PHONE <br /> ARCHrtECTORDE51GNEfi MAILqDDRESS G�Y ZIP PMONE <br /> GENEFAICOYTRPCiOP i:^.'! ADDRE55 CiTY ZIP pHONE STATELICENSE• <br /> �D VhRSa.l'�IC�U�13C�_p�SZg Px�►E���NAht)OOD �60'S7 �S-Sb'3S �FDNrf� 11�4W1 <br /> 1dEGHlNiCALCONiRALTOR AIAILAD�FEtiS CITY ZIP PHONE STATELICENSE• <br /> PLUMBINGCONTRAGTOR IdNLApDRE55 GiV ZIP PHONE STFTEUGCNSEn <br /> �pt iTRAC�f'T P�FICE OF\YOflN <br /> �.-�VO� <br /> DESCRI�E WORK AN�SOUAPE F WTAGE INVOWED CONTACT PERSON ANC PNONE NO. <br /> I�F�'t, ol i�f,. �4s�o�-r' Sf�vc.T��c l <br /> N i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED U1S�:`OF-BU.IL MG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> N C�U T1�MQ �S�N FqI E � I PROVISIONS OF LAWS AND ORDINANCES GOVEtiNING THIS TYPE OF <br /> �Eca�oescaianor+oFaaoaearr�y�[Nowriee�owq)g,�q nncNrwoco^ai s� WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� BLOCK.'l7_ oF �`�� OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> '�'c � 1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �N T���T�I �I�v��I ON NO. I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ---—r PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION iS MA AND I COMPLY WITH THE STATE <br /> rnN e�Tna i o Nuuoea CO TO 1 . D 296200 WAC. <br /> � b2 -b0$. —bpo <br /> CONSTRUCIIOYLOANIEN�ER.ADDRE55.TELEPMONE NUMB[R <br /> � ' � <br /> P�70JECT Af�DRC � � sicH . o�ie <br /> i� E m ��,.a�s•��ss�����s,�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.F. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATOFV�WASH BASM) I UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYEFS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUMP � <br /> BAGKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EKHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> SUB TOTAL $ ; SUB TOTAL 5 <br /> PERMIT $ PERMIT S � <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETBACN PIANCHG K U Eii iEE RECEIPTNO. <br /> i �3 <br /> usEzor+e �orneen VACANTSITE FEES VALUATION FEE <br /> �—� YES ❑ NO BUILDING <br /> TYPE OF LONSi. NO.OF STORIES accu=nvcv r,o o�mv¢un,mr.ts ` <br /> caa_�o PLUMBING , <br /> �- <br /> SREOFBLDG. FlRESPRINRLERSFEO'0 BASEMENT MECHANICAL <br /> � YES NO <br /> � <br /> OCCUPANCYLOFD FIREALAPMqEOD MEIGMTLRdITATION ADDITIONALPLANCHECK � <br /> � <br /> OTHER � <br /> BEASON �— <br /> STATE�UILDING SURCHARGE � <br /> INT4KE BV PLANSAPPROVCDBV CITY OF EVERETT PU�LIC WORKS � <br /> LOCAL SALES <br /> DaiE TAX CODE IS 3105 TOTAL i <br />