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APPLIC�►TI(�1 FOR CONSTRUC7�'JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ���5� <br /> HEATING SYSTEM• jZ�GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> f] DEMOLITION ❑ COMBINATION f l BUILDING IXMECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER <br /> MAILAODRE55 CITV ZIP PMONE <br /> i HD� �ON�t�coa ll Z�i N%�i�� %�✓ w'�%r 9P2o i -i 6R 2 9 <br /> TENRNT <br /> MRII AODflE55 GITY ZIP PI ONE <br /> ��ry ZIP PHONE <br /> ARCHITECT ON DESIGNER MRIL AD�RESS <br /> GENERALCONTRPGTOR MAILAD�PESS <br /> GTY 21P PNONE 5T4TEUCENSE• <br /> MECMANICALCC9TP�OTOR MRILADDRE55 ��TV Z�P PHONE STATFLICENSE� <br /> � �UIeOPA UJN��Iuc /47Z� L�f�`d,k W LYA1.w0ob 9�d3 6 )�CO'i7� CIJ,COPcGZ�E/U4�N �G� <br /> PLUMBINGCONTRPCTOR MAILADDRESS <br /> CONTRRCT PRICE OF WORN <br /> �—`�� O O CONiALT PERSON ANO PHONE NO. <br /> OESCRIBE WOFR AN�SOWhE FOOTRGE INVOLVED <br /> �aPr.c� D,'/,�rsaau + c!¢��G� �-� <br /> � n� }t,�„n�p 1�.�-�.a�P�-.--� I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEC THIS <br /> PROPOSED USE OF uaow� APPLICATION AND KNOW THE SAME TO BE TRUE AhD CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE OF <br /> IEGALDESCF�P IONOFPR�PEHTY�SNOWNBELOWORATTFGHTWOGOPIES� NOT THE`GRANTOING OF A i�ERMITJDOES NOT PR�ESUMEETO GNE <br /> iaT B��K oF AUTHORITY TO VIOIATE Oli CAtJCEL THE PROVISIO�S OF ANY <br /> OTH[R STATc OR LOCAL LAW REGULATMG CONSTRUCTIOId OR THS <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TH? <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIC�i <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%1 D.NUMBER CONTRACTORS LAW 18.27 RCW AND 2%200 WAC. <br /> CONSTNUCTtON IORN LENDEF.AODRE55,TEIEPNONE NUMBER D // � /� ` �� <br /> Y tili�w�I � o�rc <br /> SIGNAiURE � <br /> PROJE ADDRESS C cirreusmcssuccMSErvo — � <br /> G <br /> MECHANIC�L � <br /> PLUMBINa FEE �. <br /> Np, TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. ' <br /> FORCED AIR SYSTEMS-�B.T.U. M E.A. <br /> BATHTUB ; ; � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M . <br /> CLOTHES DRY[RS . <br /> SHOWER VENTILATION FAN � <br /> KITCHEN SINK 6 DISP RANGE HOOD ' <br /> DISNWASHER � y�pTER HEATER � <br /> LAUNDRYTRAY ' � <br /> � CLOTHES WASHER � WO00 STOVE � , <br /> METAL FIREPLACE(WOOD BURNING) ,;_._ <br /> URINAI � FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN HEAT PUMP <br /> FLOOR DRAIN Z GAS PIPING ' <br /> BACKFLOW PREVENTERS ' , <br /> ROOF DRAINS—RAINLEADFRS � E%HAUST FAN - <br /> � <br /> � �_ <br /> SINK(SERVICE—$AR.ETC.) <br /> � I� <br /> � � <br /> i --T <br /> , SUB TOTAL $ � 'OU <br /> SUBTOTAL $ pERMIT S / � <br /> PERMIT S � TOTAL FEE $ '�V <br /> TOTAL FEE $ � . <br /> FOR OFFICE USE ONLY: ReceirTr+o <br /> PRONTSETBRLK <br /> REpRSETBALN SIDESETBRGK PLANCHECKNUMBER FEE <br /> FEES VALUATION FEE <br /> USE 20NE LOT AREA VACANT SITE � <br /> i_1 YES ❑ NO BUILDING � <br /> NO.OFSTORIES aawucr xoovmaiuxruwn ; <br /> 1YPi Of LON57. cnauv PLUMBING ' <br /> SREJFBLDG. FIRESPRINNLERSREO'0 BASEMENT MECHANIGRL � <br /> c ves ❑ No ' <br /> NEiGHT uurc�nor+ ADDI710NAL PLAN CHECK <br /> ; <br /> OCCUPANCV LOAO FIRE ALARM REO�O � <br /> OTHER <br /> FEASON STATE BUILDING SURCHARGE <br /> i <br /> INTAKE BV PLANS AP7ROVED BV CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES ; <br /> DATE <br /> TAX CODE IS 3105 �T�� <br />