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APPL:CATIC`�1 FOR CONSTaUCT�-�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS fJ ELECTR�C J _ —� <br /> BUILDINr� DEPARTMENT <br /> 259-8810 <br /> I D�M7LIT!ON I 1 COMBINATION �( BUILDING �MECHANICAL JZPLUMBING i_1 SIGN <br /> �OY Eq �.MAILA��FE55 Clit ZIP PIIONE �////Q , /�,7393 <br /> ,✓ u/L�C�?i-ctc�louJ _I-�+c. 2?�Z-g=-.�1���_�--- �� <br /> T�;NT M�ILFO�R�j 55 CITV ZIP PNONE ��� ��OO <br /> lryf G^ ji� r.tt.�s /�r7<fcJQST . 'Sn � ��u�' �NOd�i.�///G <br /> "ATiC ;C�ORDESIGNE° MAILA IiE55 —� CITV 21P �HONE <br /> �a(�1 cii E cs ,Z�'�T� .da� S ,o �:a,�d / c-/��• 7 3 9S <br /> GP �LCONTf.AC10R J41 ADDRE55 CITV 21P PHONE STATELICENSE♦ <br /> hoev, ��:��.��_C�—!f/oH��,�l-� G�$�3�.5 <br /> E ��ANICALCONiRAGTOR �A�IA�DREES� CITV ZIP PHONE STATELICENSEY <br /> �v : 6iI . ��e�L.��%�., ��z o/3 S' - <br /> PLUAIBING ONTPPCTOF IANLADJRESS CIiV ZIP PHONE STATELCENSEa <br /> CONTRt.GT PRICE OF 1'/JRN <br /> S F2 / l�fs� <br /> DESCRI�E WORN AND SOOQRRE FOOT4GE IYVOLVED �IDCt PERSON AND HONE N� _ _ !�/ ��^� <br /> ��/G �Lj�!_l�f�/� ' n y <br /> i HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> P POS[DUSEOF 0 LDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �d �y�f�CQ PROVISIONS OF LAW�AND ORDINANCES GOVERNING THIS TVPE OF <br /> i�oescai�lONOFPR�[RTVISHOWN�EI woannnc�rnvocoa�esl N�R THELGRA TWG OF AD ER 11TIDOES NOT PRIESUMEETOIGIOVE <br /> �or� O��K — OF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL L�W REGULATING CONSTRI�CTION OR THE <br /> — PERFORM�NCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> � �(i l/�_ OWNER OF THIS PflOPERTY TO PERFORM THE \VORK FOR WHICH <br /> C '� APPLIC ION IS MADE AND I COMPLY WITH THE STATE <br /> aaacter�rna i o r+ma �r+ CONTR TORS LAW 1827 RCW AND 296.200 WAC. <br /> /y <br /> YSiRIICTIONLOAHLEN ER.PDOR[SS,TELEPNO4ENUMB[R /� �� <br /> � /D/_ / ��r, .iGN�IUfIC O�IE� <br /> PROJECT ADDRESS - - <br /> rnv nus��i[ss uu•+sc mo <br /> PLUMBING MECHANICAL <br /> Np, TYP�OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) / ArC—A.,HNDLG UNITS—H.P. <br /> BATHTUB i' / FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) U UNIT HEATERS—B.T.U. M � <br /> SHOWER CIOTHESDRVEFS ' <br /> KRCHEN SINK 8 DISP / ; VENTILATION FAN __�_ <br /> I �r— R�NGE HOOD <br /> _ _ DISHWASHER WqTER NEATER � <br /> LAUNDRY THAY _ � � <br /> —� CLOTHES WASHER i WOOD STOVE ' <br /> URINAL h7ETAL FIFEPLACE(WOOD BURNING) <br /> DFINKING FOUNTAM FIREPLACE INSERT <br /> FLOOR DRAIN fiEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING % <br /> ROOF DRAWS—RAINLEADERS EXHAUST FAN /,�� _ - <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL 5 � SUBTOTAL 5 <br /> PEHMIT S PERMIT S _ <br /> TOTAL FEE $ TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: — ReceiarNo ,� <br /> FRONTSETBACK REARSETBALK , SIDESETBACK PLANCH[C NUM�E PEE �� � <br /> ?.o � Z� �- � /32� ��j� , 1� �,���;�� <br /> USE ZON' LOT AREA VALANT SItE ��� <br /> FEES VALUATION FEE <br /> �,�� �C�� � ves i: No ouaoiric 6/ �(� __---_�711/�-��.Z� <br /> t�PEOf[ONLI No.OF5T09i[3 aauncvcv rvoarowuuxcmms �O ; <br /> -ac.o pLUMBING <br /> -1� �•3 � � (� -- <br /> E2EOF04�G FlfiESPRINCLER5RE0D 9ASEh1ENT ./ MECHANICAL � <br /> j1� y5E Gpll Q :, YES �— �+� _ll� <br /> PDDITIONAL PLAN CHECK <br /> OLCOPANCY LOAD FIRE ALARM REO�O NEIGRT iMRAT10N� � <br /> / <br /> ��� � g or�a- �j�(/I� � — <br /> NEAs�N £7AiE BUILOING SURCHARGE � ' <br /> ininKE nv r�nrvsaarrvov�o n� CITY OF EVERETT PUBLIC WORKS �JJ; _ <br /> ,� LOCAL SALES <br /> 3 TAX CODE iS 3105 TOTAL <br /> �A,Eg G 9 _ <br />