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APPLICATIC"Y FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS �ELECTRIC � IJ�e ��� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> Cl DEMOLITION LI COMBINATION / BUILDING i ;MECHANICAL I� PLUMBING � SIGN <br /> OWN1'ER MAILADDRESS r CITV 1 I� ZIP PHONE <br /> CV3�te���and �4i6R���(ct�C�la� �= �e� c�7 4.1v . .'�3°�-�1.5-3 <br /> TENqN� � l I MAIL�DRf55 � \ QtY 21P PHONE <br /> CQ 1 4n�1 1�4t Q o�+L' / <br /> ARLNrtECTORDE5IG� MAILF ORESS CITV 21P N�'ONE <br /> �W��r <br /> �GEN LWNiRACTOR \ MAILADDFE55 GITY ZIP PHONE STATELICENSE� <br /> nv��,� r 1 <br /> MEGNA ICAL CONTRACTO MAIL qUDRE55 diV ZIP PNONE STATE ULENSE e <br /> PI UMBING LONTRACTOR MFIL ADOflE55 CRV ZIP PHONE STATE LIGENSE 1 <br /> LONTR�CT PRICE OF W RK <br /> � <br /> DESGFIBE WORN AND SOUARE FOOTRGE INVOLVEO ^ � � GON�CaT Pi PSON AND,11,�p0 2�Z_�L 3 3 <br /> t� <br /> �� o e �e.�Eos1�1�Y1�T.�e <br /> / � <br /> c. Nwi. � � o area _ 1 z� 5 i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE CF�UiI�ING 1 ��� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ►IU Rat S�d8 v�CC PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ieca��oQe�!PTION 7NOPEFTV�SIIOWNBELOWORRTTRCNT1WOCOPIES) 1 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or-�/�--�26BLOCK 2q oF T"H t F��`"S I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � � � I �'J,� �� �^ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 1= V t✓'C OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED BV THE <br /> ' OWNER OF THIS PROPERTV TO PERFORM THE WORK FOfl WHICH <br /> APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PARGEL TAX 1 D.NUMBER CONTRACTORS LAW 18.f RCW AND 2 6200 WAC. <br /> 4 -191 ^ �2�- v0�8 <br /> CONSTRUCTIONLOnNLENDER.AD�RE S.TELEPHONENUMBER r ^ �j <br /> er o S 't' <br /> PROJECT ADDRESS F " "`u"r J o��E <br /> �q I� a�1 Fe r �� r r ��r. �s�„Es�,����sE�o _ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—NHNDLG UNITS—H.P. <br /> BATHTUB FOFiCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HI'.ATERS—B.T.U. M <br /> SHOWER CIOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP - ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ' WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) '_ <br /> ORINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR ORAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) I <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SVB TOTAL S ' <br /> PERMIT $ I'ERMIT $ � <br /> TOTALFEE $ TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> PPO":f SET�AGK REAR SE7BACK $IDE SETBFC�K PLAN GM CK NUMB % FEE� . OS REC 0 <br /> � O� �fx&.W B 5 — �/7� <br /> usezoNe O ioT eEa vncnNtsrte FEES VALUATION FEE <br /> �_'� �,{ ❑ VES i� NO BUi�DWG O I ' ` <br /> TVPEOiLONSi. NO.OFS70BIE5 awrexer xoaoxew�.awws <br /> — � 01P PLUM9ING � <br /> 1 <br /> SREOFBLDG. FIPESPRINKI.ERSREOD �ASEMENT / MECHANICAL � <br /> � V ❑ YES I�NO — i <br /> OCCUPANCY LOAD FlRE ALARM REO'D HEIGNT LIMITATION ADDITIONAL PLAN CHECK <br /> � / r � <br /> /I� � �I7 OTHER ; <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> — i <br /> INTANE DY PLANS� PR VED BY CITY Of EVERETT PUBLIC WORNS T <br /> LOCAL SALES � <br /> ORTE �ZI y TAX CODE IS 3105 T�TA� 2 ' <br />