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APPL�CATIQ"'1 �'t)R CONSTRUCT' lN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT •'� <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259•8810 <br /> ❑ DEMOLITIO�� I�I" COMBINATION I 1 BUILDING ❑MECHANICAL CJ PLUMBING ❑ SIGN <br /> ONTlER M�IL A�DNESS CITY ZIP PHONE <br /> �)�� �lom[S /nc Z37 E�N s�- c��v�v� 9PLc3 �sR-, �e3 <br /> TElUryT M�ILRDDRE55 CITY 21P PHONE <br /> �RCl/ITECTORDESIGNER MAILADONESS CITY 21P PHONE <br /> GENERQCONTRAGTOR MAILRDDRESS CITY ZIP PHONE SiATELILENSE� <br /> ca�,� u.,.M. Jn� z37 �/m S� E r.�l� L�/� zs��rn� sele�h� ri�K.J <br /> MECH�NICAIC T ACTOR MMLAODRESS ���� 21P PMONE SUTEL�CENSE• <br /> PLU'aBINOGONTR�CTOR MAIUDDRE55 CITY ZIP PMONE STATELICENSE� <br /> CONTRACT PRI/CE OF WORK <br /> DESGRIBE WONK A D�RE FOOTRGE INVOLVED CONTFCT PERSON AND PHONE NO. <br /> ZS 8-)So <br /> /�sreuc.T 1,,�;��cC — <br /> �/KSIG /!l�F+EV� /���� � i HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> � ?ROPOSEO USE OF BUILDING APPLICA".JN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � !)F� PROVISIUNS OF LAWS AND ORDINANCE5 GOVERNING i HIS TYPE OF <br /> LEG�LDESLPIPTIONO:'PROPERTV�SHOW�BELOWOR�Tf�CHTWOCOPIES) NOT. THELGRANTOING OF A ERMIWDOES NOT PRIESUME TO GIOVE <br /> � �or e�ccK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �' I vG ��' �—1 �� r�g � � 4��� pF.RFORMANCE�OF OONS RUCTION.THATG AM AUT ORTZ�D BY THE <br /> • �p OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � Cl� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I .NUMBEF CONTR T P i L4W i . 7 RCW ND 2 2� 00 WAC. <br /> '1�53 ao d qgq oa�� i�'� ° �� <br /> CJNSTRUCTION�MNLENDER.ADDRESS.TELEPHONENUMBER � ��� <br /> �� D�*E <br /> ppOJECTADpRESS s�cv.rUrt <br /> ' `8�� / � � ci*vouswcss�w[Hscra <br /> t7 <br /> � PLUMSINQ MECHANICRL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) � AIC—NHNDLG UNITS—H.P. � <br /> ' BATHTUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BF�SIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHESORYERS ' <br /> � KITCHEN SINN 8 DISP � VENTILATION FAN � <br /> 1 DISHWASHER RANGE HOOD <br /> LAUNDRV TRAY WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAI METAL FIFEPLACE(WOOD BURNING� <br /> DRINKING FOUNTAIN FIREPIACE INSERT � . <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> � RCDP DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> --� <br /> � <br /> — --� <br /> � <br /> SUBTOTAL $ ' �' SUBTOTAL $ <br /> � �-�-- PERMIT S � <br /> PERMIT $ � <br /> TOTALFEE $ TOTALFEE S ' <br /> FOR OFFICE USE ONLY: �Ecey�N� � <br /> FRONTSETBALK BEANSETBACK SIDESETBACK PLANCHEGKNUTAEER FEE <br /> 3%l�3 .-3� Q <br /> LOTAREA VACANTSITE FEES VALUATION FEE <br /> USE 20NE i <br /> {'��� ❑ YES ❑ NO BUILDING '7�J PS�� � ' <br /> l� <br /> NO.OF£IOFIES otcUMNtv NOaV.nWxGuw15 � T) <br /> TYPE OF CON51. i (/ <br /> �AWP PWMBING U <br /> �1 � / I <br /> SIZEOFBLDC. FIRESPfINKLERSREdD BASEMENT MECHANICAL � <br /> /58/ Sr 't' �p ❑ YES �k� NO � <br /> G6Z 5 f �A ADDI710NAL PLAN CHECK <br /> OCCUPANCYLOAO FIREAVRMfikO'D I HEIGMTLIMITATWN � <br /> �— 'J �/ OTNEfi U � <br /> REASON STATE BUI:DING SURCHARGE � � <br /> INTAKI:BV PUNSAPPROVEDBY CITY OF EVERETT PUBLIC WORKS D� <br /> ��� LOCALSALES 5� ; �� <br /> oa.E 3 ZZ y3 <br /> TAX CODEIS 3105 70TRL <br />