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� <br /> APPLICATIOrr FOR CONSTRUCT["�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: J GAS J ELECTRIC �.J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> QE!'M� OLITION � COMBINATION BUILDING MECHANICAL PLUMBING �CSIGN <br /> OIYNERT4,�"�y"��'J1 lAAILADDRE55 CITV 2iP PMONE <br /> P�h� ��c�NS i5�ta3 u�.�zY� Go�w�a.. t� ���u"a`� �sz- s�ag <br /> iL ANT IdAILADORE55 CITV 21P �'HON[ <br /> �5�'+tr� 28z8 /L���},r_� ��rr 9Y�/ 33�- `/6y� <br /> ARCNIiECTOR0E51GNER N�IL�D�FESS CIIY ZiP PNON[ <br /> GENERALCONTRALiOR MAI�pDORESS GiV 2iP �HON[ ST�TEUCENSE� <br /> $�NEoN 1►�G Po�B�e,c szc, Ly Nwoo wA 9Poy6 776-b�3�S � uc o7�cM <br /> MFC/IAN�LALW'lTRAGTOR �dAil��0�E55 CIiV � ZIP PdONE ST�TELICENSE� <br /> PLUTABINGLONTBICiOR MFILAOONE55 dTV ZIP PNONE STf.iEL�CENSEt <br /> C TRACt PRILE O�O�N <br /> ��SS°— <br /> OESCRiPE WORK AND SOUARE FOOTAGE INV�IVED CONiACT PE ON�N P��ONE NO � � OQ�. <br /> . 00�7 <br /> INsrA� C1� ► ztb Deu�E F+�►�/�e <br /> � �p L � N I HEREBY CER1lFV THAT I HAVE READ AND EXAMINED THIS <br /> rr+oaoseo use oF ouaowc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iEcn�oescnivnorvoFanoaeArvisnowNoeiowonnrrncNTwocoaie!s ' WORK WILI BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �_ �C1 -0O DIA'T OG G�'��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT o�ocn oF —r pUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.iHAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> -- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Pu39 nx/ 70Oa/f' o o D� CONTRACTORS I_AW 7027 RCW AND 296.200 WAC, <br /> 7 10 7 <br /> CONSTRUCt10NlOANlENOEF.AODRESS.TEIEPHONEYUMB[R /� <br /> ci4vliV . ��' /. /01� • <br /> PROJECTADDRE S � <br /> 2 � Ci1VPJ5'NCSSIiCE�:�f NO <br /> PLUMBING MECf1ANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATFR CLOSET(TOILET) AiC—A'NNDLG UNIiS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEAIERS—B.T.U. M <br /> SHOWER CIOTHES DRYERS � <br /> KITCHEN SIIJK 8 DISP VENTILATION FAN <br /> DISHWASHER RAtJGE HOOD _ <br /> LAUNDRYTRAY WA7ER HEATER <br /> CLO7HES WASHER WOOD STOVE — <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOF DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS i GAS PIPING <br /> ROOF DRAINS—RAINLEADEFS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT 5 PERMIT S <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: AeceiP.r+o <br /> FRONTSLTBACn PEARSETBFCK SID[SETB�CK PLANO�[GhNU1d5ER �EE ��6L� � <br /> _� riri <br /> \�C/ <br /> y�qRE� vacnNrsrte PEES YALUATION FEE <br /> USE ZONE d � <br /> C` I �� / YES � NO BUILDING _ __ <br /> IYPfOFCONSi NOOFSTOFIES o:r�rn•„v r;�o��wmn.c.,�n <br /> �°o�° PLUMBING <br /> SiZEOFBIDG. FlRESPRINKLEFSREOD BASEMENT MFCHANICAI. _ <br /> -� YES I— NO — — <br /> � PDDITIONAL PLAN CHECK <br /> OCCUP�NC�IOAD FlRE�IARM BEOD NE�GIIi LiMITATION — <br /> (.,i�M�� •"� ��u OTHER <br /> _ � <br /> REnsorv STATE BUILDING SUNCNARGE <br /> INTAKE 6Y PlANS APP 'ERev CITY OF EVERETT PUBLIC WOAKS <br /> /A,, LOCAL SALES <br /> naie �V_ <br /> ,� 4 TAX CODE IS 3105 TOTAL <br />