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APPLICATIC�'� FOR CONSTRUC7'7N PERMIT <br /> TO 8E COMPLETED IN BLACK INK—PLEASE PRINT � <br /> ��.�., <br /> BUILDING DEPARTMENT HEATING SYSTEM: ;�GAS :]ELECTRIC ] <br /> 259-8810 <br /> ' DEMOLITION I ; COMBINATION ; BUILDING _ / <br /> OWNER (/MECHANICAL �1.�LUMBING - ' SIGN <br /> �.�// w���/IAAIL ADO�L/5� LITV '� <br /> � i ynZ��P PHON2E /� <br /> �NANT l��//�AD�RE55 �u � CI�r� `i/�i�I �/ J��I N�il/ <br /> /�c J , !C��- � J / ZIP PMONE <br /> � - �J� <br /> v y i �G O=�,j � <br /> /�CNITECTORDESIGNEN MAILADDRESS I - <br /> ��T� Z�P PMONE <br /> J p(/�lc.i(�T OC��,�IL A�/ta� � /� <br /> GiV PH04E <br /> '��lsft�� /��`y Si EIICENSE• <br /> ��ECHANICAICpNI ACiOR IA�IL�ODRE55 } ,L ys"/ ��3-37Z� /�o,�S���y�� <br /> CIiV PNONE <br /> G��� Z�P STATE IICENSE> <br /> PL gY LONTRACTp� � MAIIFDORE55) <br /> 1� �i ��i�H!/�r� �JL �� syT,/ ,/ C,d��P .0 rHONe 51nte LUE%sE a <br /> CONTRACT PqILE OF WOFK <br /> J.---�_ wV,, / o � �,3�.�33 A r� <br /> DESCRIBE WORK AND SOUAqE FOpTqG[INVOLVED <br /> WNTpCT PERSON AND PNONE'J0. <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALOESCFIPiIONOFPROPEFTV�SHOWNBELOWOqqRACHTWOCOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> iot — B��K �F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER S1ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WNICH <br /> PARCELTA%IA NUMOER APPLICATION IS MADE AND I COMPLV WITN THE STATE <br /> CONTRACTORS LAW 78.27 RC AND 296200 WAC. <br /> CONBTqUCTIONLOANLENDER.ADDRE55.TELEPHONENUMB[R /// <br /> PROJECTADDRES • � ����'j� <br /> 3o swrv runc o,E <br /> �� � �� �� )4NC951iCFN5fN0 <br /> t PLUMBING — <br /> � Na• TVPE OF FII(TURE OR ITEM MECHANICAL <br /> FEE NO. TYPE OF EQUIPMENT <br /> � WATER CLOSET(TOILET) FEE <br /> BATHTUB A�C—A�HNDLG UNITS—H.P. <br /> LAVATOFY(WASH BASIN) 2 FORCED Alq SVSTEMS—B.T.U.J E.A. <br /> SHOWER UNITHEATERS—B.T.U. M <br /> _� KITCHEN SINK 8 DISP � CLOTHES DRVERS <br /> DISHWASHER VENTILAi ION FAN <br /> � LAUNDRV TRAV RANGE HOOD I <br /> CLOTHES WASHEa WA7ER HEATER <br /> URINAL H'OOD STOVE � <br /> METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSEqT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING �— <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SEFiVICE—BAR.ETC.) __�__ <br /> �— <br /> SUB 7t,TAL 5 <br /> PERMIT g _ SUB TOTAL $ . <br /> PERMIT � <br /> TOTALFEE $ � TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: �� � <br /> FqONi SETBACK REAq SETBFLK S�DE SEiOACN PLhN CHE K NUMOCR F[E <br /> �IfL� AECEIPT NO <br /> US[20NE �OTpREA VACANTSIiE <br /> _ FEES VALUATIOM FEE <br /> ! YES ❑ NO <br /> iYCEOfCONSi NO.OFSTOFIES �UILDWG <br /> acuvnxn xo o�ovrtun�o urms <br /> caour --- <br /> PLUMBING � i rn <br /> 9ZE OF 9LDG. FiRE SPqINNLERS REO'D BASEMENT � <br /> . �'ES �'� NQ MECHANICAL n ; (, <br /> 1/ <br /> OCCUPANGYLOAD FIREALAqMREOD H[IGHTLIMIiAT10N ADDITIONALPLANCHECK <br /> RE�SON �THER <br /> STqTE BUILDING SURCHARGC --�— <br /> MTAN[9V PLANS APPROVED BV CITY OF EVERETT – <br /> LOCAL SALES rU�LIC WORNS <br /> onre TAX CODE IS 3105 rorA� <br />