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_ _ <br />� <br /> APPLICATIQ'"'1 FOR CONSTRUCT�°�!N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �ELECTRIC ❑__ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ CON781NATION �('BUILDING f 'MECHANICAL k'PLUMBING L; SIGN <br /> O R MAIL AUD'E55` �� / ���t I� Z���� `7y 7- Y.�� <br /> _;- � <br /> TENANT MAILADDRE55 CITV 11P PHONE <br /> ARCHITECTJROESIGNEP MRILAUDRESS CITY 21P PHCNE <br /> ���'� ���/ C�TV ZIP PHONF STATELICENSE� <br />, GENERALCONTRACTOF MAMLRDDRE/55 <br /> ME/NICAICONT AriOR MA�ILr�RDDRESS��A ��IT������ ?���,��STAtEL�C����� <br />� PL�JY@IA ONTRRCTOR���� MiI�RE55 CITV 21P PHONE STAiE LICENSE R <br /> � )_ /� � <br /> // U 5� <br />� � CONTRACT PRICE OF WORK <br /> I � DESCRIBE WOfiH AND SOUAf1E FOOTqGE'NVOIVE� GONTACT PERSON AND PMONE YO. <br /> i __ J/� �(/y <br />'I :� � . / LL�F_� � /! C/ <br /> C . <br />� - � I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />�� � . PPOPOSE " OF BWL NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPc OF <br /> � <br /> LEGALOESCRIPTIONOFPflOFcRNISMOY:NBELOW• A�TACHTWOCOPIESI WORK WILL dE COMPL[TED WITH WHETHER SPECIFIEG HEREIN OR <br /> I� �� � �/ � �7 �'� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE • <br /> ' . �or� e�ocK oK`-CT �-'—��-- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�i � � � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUC'.ION OR THE <br /> i ' . pERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br />� I� � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STA1 E <br /> I � PARCEL TA%I.D.NUMBER C04TRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� ' � CONSTRUCTION IOAN LENDER.ADDRESS.TEIEPMONE NUMBER �� 4'Q��� / �O �� <br /> ; i — G <br />� PROJECT ADDRE � N�rune • o�.e <br /> /o � /Y� �sl.� <br /> LrtV BUSi4E551R6Y5E NO <br /> PLUMBING MECHANICAL <br />�� � NO. TYPE OF FIl(TURE OR ITEM FEE NO. 7YPE OF E�UIPMENT FEE <br /> i : WATER CLOSET(TOILET) � A/C—AIHNOLG UNITS—H.B � <br /> I bATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />! '• . _ � LAVATORY(WASH BASIN) / � UNIT HEATERS—BJ'.U. M � _ <br />� -- - SHOWFR CLOTHESDRYERS � ' <br />` . � , . KITCHEN SINK&OIS? VENTILATION FAN ' <br /> 'T <br /> I � ' DISHWASHER � RANGE HOOD <br /> M LAUNDRY TRAV ; WATER HEATER <br />� � CLOTHES WASHER � WOOD STOVE � <br />� URINAL ' ; METAL FIREPLACE(WOOD BURNING) ' <br />� � - ORINKING FOUNTAIN � FIREPLACE INSERT � <br />�� FLOOR DRAIN � HEAT PUMP ' <br /> i ' � BAr,KFLOW PREVENTERS ; GAS PIPING I <br /> . � ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> �� �- �� SINK(SEFVICE—BAR,ETC.) I � <br /> ; <br /> �. . , } <br /> � <br /> - , � <br /> - � SUBTOTAL $ SUBTOTAL $ . <br />! , - PERMIT $ � PERMIT S <br /> I �. " —�----�-p�_ _ � TOTAL FEE S ' <br />! FO F�E USE ONLY: � <br /> " � � F NTSEiBACH PEARS BACK SIDESETBACN PL NCMECKNUMBER FEE REGEIPTNO. <br /> /S� �/ "�_� Ct�j/7� <br /> use zoyyy��� LOT�REA VACANT SITE �� FEES VALUATION FEE <br /> �j ❑ YE �C�dO BUILDINC� � 7 i�.5 D <br /> �71PEOPCOtlSL � ��� -'M1'��DFSTORIES aNrAxcr x9aowEWxGuxrts <br /> '"0i1ei PLUMBING � <br /> J <br /> $�ZE FBLD F t FIRESPRINKLEFSFEO'0 BASEMENT / MECHANICAL 9�j i <br /> 'l YES ���NO l�2 7 <br /> �� � S � FIREALABMPEOD NEIGI1TL:h11T�TION ADDITIONALPLANCHECN / <br /> p CUPANCVLOAD <br /> v n� ' <br /> �I 1 A O ZS � OTHER � <br /> PEASON T� <br /> STATE BUILDING SURCHAFiGE � � <br /> INTANE B� P��NSfjPP�ED UV CITY OF EVERETT PUBLIC WORHS �G <br /> �] LOCAL SALES � <br /> onTe ,r�3 c�,.� TAX COUE IS 3105 TOTAL ; <br />�• <br />