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APPLICATIC'1 FOR CONSTRUCT'�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEtii: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION �� COMBINATION �� BUILDING ❑MECHANICAL ❑PLUMBING i ] SIGN <br /> OWNEfl MAILPDDRESS CITV 21P PMONE <br /> Je� K��}l� //.7/ /`�,olc. Sf�✓c1�� 9�avr ��J o2359 <br /> T�N�1 �,�'L /IA��DFE/ /NJI� J fi (�✓��� �IU�� I PM�tI / �IJV / <br /> A��,To�,s�% ilpatDRES�o�e sF �v���f� 9Z��, a95a359 <br /> GENERRL !RACTOR MAI�ADDRESS CITY ZIP PHONE STATELICENSEX <br /> ����J <br /> MECHANICALCONTRACTOR MRILAD�RESS CITY 21P PHONE SiRTELiCENSEc <br /> PLUMBING CONTRACTOfl MAII ADDRESS CITY ZIP PHONE STATE LICENSE• <br /> � <br /> CONTR�CTPRICEOF ORN J i <br /> � <br /> DESCflIBE WORK ANO SOUr1RE FOOTAGE INVOLVED CONTACT PERSON ANO PHONE NO. <br /> ayxa� �fq � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS .. ;_. �p '' <br />� PPOPO ED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL � ' <br /> �(�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ' -L' <br /> LEGALDESCRIPTI NOFraoPer+n'�`isH�o}w-�neeiowoR{nn1ncHTwocoPies� _ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or ��� e�xK "'�F— oF r�fi d� ��C� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ` �� �7 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �:,�'�'bn ,�� (t�•pP�Qd j /� pt'f�J�tt. / O� p IGfS OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> PERFORMANCE 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 TH8 STATE . . ;� � ' <br /> PARCEL TA%I.D.NOMBER ���y�- '"1 ��'O� I _^^a ' CONTRACTORS W RCW AND 296.200 WAC. � � :.: � <br /> a a / vu i� <br /> r:( <br /> LONSTRUCTIONLOAN�.ENDER,RD�RESS.TELEPHONENUMBEF . ��'�?� <br /> a•,,?� <br /> /S,juf y ��.�, <br />� PROJECT ADDRf�� � s�� � o�,e � . •'-� <br /> �l /J/Q 2 �i �:HE55��LEHSE�+O. ,. <br /> �f�Cl <br /> PLUMBIN6 MECHANICAL � � '��`� . <br /> NO. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � ' � i� <br /> . L'.: <br /> WATER CLOSET(TOILET) � A/C—lUHNDLG 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 /> SHOWER ' CLOTHESDRYERS . <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAV ; WATERHEATER . I <br /> CLOTHES WASHER � WOODSTOVE t <br /> URINAL ' METAL FIREPLACE(WOOD BURMNG) � ; p ' <br /> DHINKING FOUNTAIN I FIREPLACE INSERT � � � � ��`V�'�;� <br /> ; �� j-� .�� <br /> FLOORDRAIN � HEATPUMP � , .,,,_�4-^ <br /> BACKFLOW PREVENTERS ; GAS PIPING _ '- . •�•;',. <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN . � <br /> SINK(SERVICE—BAR,ETC.) ; ' � � . <br /> � . ��.�� ;;'�� <br /> —�— • � <br /> i a ry`}- <br /> � ' 11 <br /> i � ' � <br /> SUBTOTAL $ ; SUBTOTAL S �� . � ������� <br /> yf <br /> PERMIT $ � PERMIT $ � F � ���: I <br /> TOTAL FEE $ ' TOTAL FEE $ � � � � .�.�.,^i� <br /> FOR OFFICE USE ONLY: ,� <br /> FRONTSETBRCK REARSETBACK SIDESETBACK PLANCHECKN MBER FEE RECEIPTNO. � " <br /> � � S• S 7� os <br /> o ' /D�o :;:-�. <br /> ':.,;,, <br /> USE20tlE LOIAREA vncnHrsite FEES VALUATION FEE � ' � <br /> �-L �7�12y �.� `7,p7 ❑ YES L!NO BUILDING (ps � � <br /> TYPEOfCONST NO.OFSTORIES aCurr,NCv NOOrowFunvGUNrtS � <br /> - � cnoul PLUMBING � ' <br /> SRE OF B�DG. FIRE SPRINKLERS REO'U BASEMENT MEGHANICAL ' <br /> S �0 5 u ❑ VES �o , <br /> OCCUP� FIREALARMPEOD NEIGHTLIMITATION A�DITIONALPI.PNJHECK � <br /> � �� 1 OTHER ' �( <br /> REASON 1 ��• ,.� <br /> STATE BUILDING SURCHARGE � i� } � , <br /> � <br /> INTANEBV PIANS qPPROVEDBY CITY OF EVERETT PUBLIG WORKS ' <br /> .J}'�" LOCAL SALES � <br /> OATE� 21 y y TAX CODE IS 3105 TOTAL Z � �L) <br />