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APPLICATIC`� FOR CONSTRUCT�IN PE�iMIT � <br /> TO BE COMPLETED IN HLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT H[ATING SYSTEM: J GAS U ELECTRIC f��JL —� <br /> 259-B810 <br /> DEMOUTION COMBINATION ✓BUILDING ' MECHANICAL i_I PLUMBING i 1 SIGN <br /> OWNER AIAI��pORESS CITY ZIP PNONE <br /> C IT`l U= CUCy2C.T .3(X�•L 6�.)c�'�+iri�. G�i. 9�3.c)I r�54-OHO� <br /> TLNFNT (� I,IAILApORE55 C QTV ZIP PMONE <br /> �U�icil 1'Ta..�C� �.�i{1C <br /> ARCNItECTOFDE5IGNER MAILADDRES$ GITY 21P PNONE <br /> GENER�LCONTRACTOR IdAILADDRE55 GTV 21P PMONE STATELICENSEa <br /> �1/IMPa <br /> ME � iCqL GONTRFCTOF MAIL ADDRE55 CITY ZIP PHONE STATE UCENSE u <br />� PLUMBING GONLi4CTOF MR�L AOORE55 CITV 21P PHONE STATE UCENSE P <br /> CONTPAGT PRICE OF LVORn <br /> 9l� @/73o i/�/�n, — <br />� DESCRIBE N'ORK AND SOUARE FOOTFGE INVOLVEO CONTACT PERSON AND PMONE N0. <br /> P�.,�= n, �� �� = +�, - s - o <br /> ��}C� I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED OSE OF BIIILCNG APPLICATION AND KNOW THE SAMc TO BE TRUE AND CORRECt ALL <br /> �TU'RA(qE A2EA � T/FRGtI C�'Yl� CR. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESGRIPTIONOFPPOPERTV�SMOWNBELOWORATTACHTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION Ofi 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 /> anncEi Tnx i o.r+un�aea CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LORN LEkDER.AODFE$S.TELEPMONE NGMBER �1 \ � `A •„^ , �/S I9 4 <br /> � �( �/3�/RJVU <br /> PROJECTADDRESS scr+.mne ' ��� <br /> '7� I � � LJ ertva�,�,niessueersuio <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET�TOILET) A�C—ArHNDLG UNITS—H.R � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> —�— <br /> SHOWER � CLOTHES DRYERS ' <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 � FIREPLACG INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT 5 � <br /> TOTAL FEE S ' TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FROHTSETBACK RE�RSET��CK SIDESETBACK PLANCUECKNUM�ER FEE REGEIPTNO. <br /> USEZONE LOT�REA VACANTSITE FEES VALUATION FEE <br /> ,- YES � NO BUi�DWG ///l[/ � — <br /> NOAPSTORIES oeeu�>ccr r;oerotaEur:Gun��s �n <br /> 1VPE Of CONSi. cqouv <br /> PLUMBING i <br /> i <br /> Si2E OF BIOG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ;i YES '�.-1 NO � <br /> O.'.GUPANCVIOAU FlREALARMREOD HEIGHTLIMIiATION A�UITIONALPLANCHECK i <br /> � <br /> OTHER � <br /> �- <br /> FEA50Y <br /> STATE BUILDING SURCHARGE ��� <br /> iNiAKE BY PLANSAPPROVED OV CITY OF EVERETT PU�LIC WORKS � I <br /> aA'� LOCAL SALES 3 <br /> onre 7 (i � ' TAX CODE IS 3105 TOTAL <br />