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APPLICATIC"'i FOR CONSTRUCT"')N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM:S`� GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION IJ COMBINATION I ] BUILDING `�MECHANICAL ❑PLUMBING ❑ SIGN <br /> p MAILAODRESS � CITY IP PHONE <br /> �ob ��cK-e � Jb� V� rU���,�v�� Sc,J �v �- �Sao� 3y�-�a�� <br /> TENANT �/� Idf.ILADDFESS GTV ZIP PHONE <br /> AqCHRE�fl!ES�GN[R MAILPDURESS GTV ZIP PHONE <br /> GENERALCONTflPCTO�i � MnILA�OFE55 QTY ZIP PNONE STATELICENSEI <br /> � 1 I <br /> MF.GN�NICAI GONTRACTOR MRIL RUDRE55 CITY 21P PHONE SiqTE LICENSE• <br /> n.w. a <br /> PLUAIBINGCONTRACTOR MAILRD�iiESS CITY ZiP �'MO4E STqiELICLNSE� <br /> � 1�1 C�G v�� <br /> CONTIiAGTPfjIWOFWORK �� �� <br /> u 7 � <br /> OESCRIBE WORK AND SOU4RE FOOTAGE INVOLVED CONTAGT PERSON AND PMONE NO <br /> � � l t�Y1� <br /> C� Ll� � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OP BUIL c APPLICATION AIJD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES�OVERNING THIS TVPE OF <br /> LEGALOESGRIPTIONOFPROPEPN�SHOWNOELOWORRTTACHiVJOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEfiEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME ?O GIVE <br /> iot eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTFUCTION OF THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRC`PERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> GONSTRUCTIONLOANLENDER.ADDRESS.TELEPHONENUMBER X ���^I ' �U . // ` /� /� <br /> vrv �(rh4�%�. <br /> PROJECT DDRESS 51°"��u F u•TE <br /> �/�.` ` � s� OtYBlI5WC55lICLNSENO <br /> N <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILET) � Ar�AMNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIF SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOr�V(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PAEVENTERS GAS P!PING � <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � <br /> SUBTOTAL S SUBTOTAL $ <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBALK REARSET9RCN SiDESETBACH PLANCHECKNUMBER FEE RECEIPTNO. <br /> uSEZUNE �ornnen vncnHrsire FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> iVPEOFGONSi. NO.OFSTOP�ES OCCu�/.xa x00�UxnrMGuxrtS ' <br /> caauv p�UMBING � <br /> —i— <br /> i <br /> 512EOFBLDG. FIPESPR�NKLERSREOU BASEMENT MECHANICAL � <br /> '� YES i ! NO � <br /> OCCUPANCYLOA� FiREAURh1RE0'D MEiGMTLIMITATION ADDITIONALPLANCHECK � <br /> i <br /> OTHEIi i <br /> PEASON <br /> STATE 6UILDRJG SUI7CHARGE <br /> i <br /> MiAKE BY PLANS APPROVED BY CITY OF EVERETT PUBUC WOflKS <br /> LOCAL SALES <br /> OniE TAX CODE IS 3105 TOTAL <br />