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APPLICAT'IQ"� FOR CONSTRUCT'`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEATING SYSTEM: GAS 0 ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />25J-8810 <br />❑ DEMOLITION I] COMBINATION '_ BUILDING J�n�MECHANICAL Y�PLUMBING I_] SIGN <br />OWNEP ���..� MRI�AOORESS CITY ZIP PNONE <br />f�!(�(riTt7h///� Co.L.✓c. 9���1-/��/f / SCcI, �{�,o,��i5 �r)Z!� 77/ —3RGg <br />TENANT MAILAOOPE55 CITY ZIP pHONE <br />AFCNITECTORDESIGNER MAILADDRE55 CITY ZIP PHONE <br />PLUMBINGCONTRACTOR MAllAO�RESS <br />PRICE OF WOPN / <br />-, � � � <br />i FK RND SOURRE FOOTRGE INVOLVED <br />� � <br />PROPOSED USE OF BUIl01NG <br />tfCi� ^ � <br />LEGAL DESCRIPTION OF PROPEPTY (SHOWN BELO1'I OR <br />LOT� aLOCK OF -�% <br />6aG� <br />e <br />Tj� <br />FARCELTA%I.D.�MPER ^ ` J O� <br />C–� � � '� �� � � � <br />L STRU TION`^OfANLENUER.ADj1RE55.7ELFFHO�ENUMBER <br />/l <br />PROJECTADDREJS�a� �u1� /O � <br />� �P <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />f KITCHEN SINK & DISP � <br />( DISHWASHER <br />I LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RA�NLEADERS <br />� SINK (SEFVICE-BAR, ETC.) <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBRCR REAR SETBACK <br />av ao <br />USe ZONE LOT AREA <br />7VPF OF CONST. NO. OF STORIES <br />J�-I.! 2. <br />�Zf.�BLsf �L' FIRESPR,IKL�EFSREOU <br />6 j <br />INtnNEBv PLANSAPPR�O�EOPv <br />DATE � �iJ C � <br />CITY <br />21P <br />CONTACiPERSONANDPHONE <br />PHONE SiATE LICENSE t <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRLCT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEii SPECIFIED HEREIN OR <br />NOT. THE GRhNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PEflFORMANCE OF CONSTRUCTION. THAT 1 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 />TRACTORS W 18.27 RCW AND 296200 WAC. <br />� C p <br />U,� l�c,�- l-Zi - �l `�I <br />sicr+e�une oae <br />Lltt BlI5�NE55 LiLENSE NO <br />MECMANICAL <br />JO. TYPE OF E�UIPMENT FEE <br />A/C-AlHNDLG UNITS-H.P. � <br />FORCED AIR SYSTEMS-B.T.U. M E.A. ; <br />UNIT HEATERS-B.T.U. M <br />--�— <br />I CLOTHES DRVERS � <br />VENTILATION FAN <br />1 RANGEHOOD <br />l WATER HEATER ` <br />VJOOD STOVE � <br />METAL FIREPLACE (WO00 BURNING) ! <br />� FIREPLACE INSERT � � I <br />HEATPUMP � <br />.g GAS PIPING ' <br />. E%HAUST FAN ! <br />aun i�in� a <br />PERMIT S � <br />TOTALFEE $ , <br />SI�ESETBACN PLANCM KNUM�Eq FE ' / <br />i � �� � _ �7• �� <br />VACRNTSITE FEES VALUATION <br />❑ YES ❑ NO BUILDING 5 (p <br />MCUMI:[Y N0.01UY[lIiHGUNi15 <br />°p I PLUMBING <br />BASEn�ENT �� MECHANICAL <br />❑ YES t� NO <br />MEIG � y�rnT1oN AODITIONAL PLAN CHECK <br />r <br />Q OTHER ,�,�� N <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />A <br />� <br />