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APPLICATIO_. FOR CONSTRUCT, IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑GAS UELECTRIC U _—_ 1 <br />_ <br />BUILDING DEPARTMENT j <br />25R 8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />DNNfP MAN, ADDRESS C'" ZIP RgNE <br />I1. a T. At, 1 1 _ ecT'r A ELJ A.. L. _,_w -tlJ�/ 6,-v, ??v- 4-f—D <br />TENANT ' MAN, ADDRESS CRY <br />ARCH:nCIORDESKWER <br />MALADDRESS <br />CITY <br />DP <br />PIgNE <br />OENERALCQ.II.ACLOR <br />:AILACCRESS <br />CITY <br />ZIP <br />PIIgR <br />STATE LICENSEE <br />MECNAN6K CpITRACTCR <br />WS ADDRESS <br />CITY <br />ZIP <br />PNCNE <br />SIATELCENSE• <br />RUMBMO C<N1RI{TDR <br />MAIL ADDRESS <br />CRY <br />ZIP <br />RgNE <br />STATELKENSE• <br />CLASSCEWCRK <br />R.. ARRI.. IN <br />-,ATTFRATTnN <br />✓RFPAIR DEMOLITION <br />WOODSTOVEFRPL INSERT <br />BUILDING RELOCATION <br />.� �y��y <br />CON1RACi PILE OK WORK lei-�'^^ <br />CDN1A��Ci��PEP',P,1A.I.��AND PXDt1E NJ ,[I- <br />DESCRSE W JPK AND SCUAREN EtAOE INVOLVED <br />try Lari,fe:4 ,1 . ,,#i ; <br />PFEoroseDlrsulLDna �.. <br />�+7'•FT•L e <br />(20C� 33 T- 3 S 37 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPE_CT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF. CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONa TRUCTION. THAT 1 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 />CONT CTORS LAW 10.27 RCW AND 296.200 WAC. <br />X -� <br />LEGALDESIAPTIONOE PROPERTY ISIDvm BELOW OP ATTACH PamcoPlEsl <br />w'__ BLCLK o' <br />-- <br />PIgIFC1 ADDRESE <br />-eN,,g k.L Av4! EVe1-cBE <br />ENY <br />I TV AI <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-A HNDLG UNITS-H P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASINI <br />UNIT HEATERS -BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHCR <br />RANGEHOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE S CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />DACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUSTFAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL AS <br />SUBTOTAL EPERMIT <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE $ <br />enn ACCIPC Dec FINE V. <br />F ROAR SETBACK <br />i <br />REARSETBACK <br />STOIC SETBACK <br />PWI CHECK MIMBEP' <br />vim <br />IEF <br />RECEIPT NO <br />- <br />USEZwE <br />LOT AREA <br />VACANI SITE <br />_ <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />-^) <br />TYPE IN CBNIS ALLOWABLE <br />MF4N5T ACtLW <br />V N <br />MVMvv A],AEP .OMuiII: MnE <br />— IwIV; A) BLov <br />EDEOEB <br />NDSTCg85 <br />BASELINE <br />`T/%S <br />MECHANICAL <br />ADDITIQNALPLANCHECK <br />9;7ti <br />OCCUPA mA0 TIRE <br />•�SP,RNKEERSPECE NEGNIIMRATKn <br />'a2 ND •3'r <br />REASON Ep16PPMKLEAS <br />/41 /� GT'L _ <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />MTAKEBrt• <br />RAHSAPPROVEOBY <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />tJ:% <br />TOTAL <br />i <br />