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APPLICATIQ`I FOR CONSTRUCT'�N PERMIT � <br /> TO BE GOMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT ��ATING SYSTEM: J GAS �ELECTRIC ❑ <br /> 259-8810 <br /> I� DEMOLITION U COMBINpTION Ll BUILDING �:�MECHANICAL ❑PLUMBING L SIGN <br /> OWNEF MAaRODFE55 _ GiV Z�P PNONE <br /> s�i'cr� 3�ord ,�(��r�e � F✓ ��� ? 3y'�- aa�a <br /> TENANT —M/�1 ApORE55 CITV ZiP PHONE <br /> RRCNRECTORDESIGNER MAILAODRESS CITY =iP PMONE <br /> GENER CONTqqCTOR MARADDIIE55 Cltt ZIP PMONE STATELILENSE� <br /> G�,,��� <br /> MECMANIGAL CONTRACTOR MFIL pDOPE55 GIiY IiP PNpHE STATE UCENSE� <br /> PLUM71NGCdJTRACTOR MAILADORESS GTV ZIP PMONE STATELIGENSE• <br /> CONTqACT PRICE OF WORN <br /> DESCRiBE WORK AND SOU�RE FOOTPGE INVOLVED CONTAGT PERSON AND CHONE NO <br /> I UQ ' <br /> i HEREBY CER'�IFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOP aoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 7 PROVISIONS OF LAWS AND ORGINANCES GOVERNING THIS NPE OF <br /> �E�n�oescairnon PROPERTY�SNONTlBEIOWOHAiTACHTWOCOPIE57 WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> NOT. THE GRANTING OF A PERMIT DOES �10T PRESUME TO GIVE <br /> �or e�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHE-R STATE OR LOCAL LAW REGULATING CONS'�RUCTION OR THE <br /> PERFORMANCE OF:ONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> PARGELTA%ID.NUMBEP APPLICATION IS MADE AND I COMP�V WI�H THE STATE <br /> CONTRACTOP.S LAW 1827 RCW AND 296200 WAC. <br /> LONSTRUCTIONLORNLENDER.ADDRESS,TELEPMONENUMBER <br /> �� N �L <br /> PROJECTADDRE s�cv+run�� ���'�� o.re �' � <br /> � � QtV BVSM65liLCNSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) ArC—FUHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYEFS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAV WATERtiEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DflINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOF DRAIN HEAT PUMP <br /> BACKFLOW PPEVENTERS GAS PIPING <br /> ROOf DRAINS—RAINL�_qDERS EXHAUST FAN <br /> SINK(SERVICE—BAR ETG) <br /> i <br /> SUB TOTAL S SUB TOTAL 3 <br /> PERMIT $ PERMIT $ <br /> TOTAI FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBPCK PEAR SETBFCN SiDE SEiBACK PLAN CHEC4 UMpE�i� FEE RECEIPT NO. <br /> J 0 <br /> use zoNe �oT aaea vncnr�r srte FEES VALUATION FEE <br /> : : YES ,7 NO eUiLOiNc �(a;� <br /> iYPE OF LON57. <br /> NO.OF STORIES occur�xcr No w mvFuiNGUNrts i— <br /> snouo PLUMBING <br /> S�ZEOP6LOG FlRESPRINnLERSREo'D BASE1dENi MECHANICAL <br /> �-�. YES :i NO � <br /> � <br /> OCCUPANC�LORD FlR[TL�RMREOD MEIGHTLIMITATION ADDITIONALPLANCHECK <br /> OTHER ' <br /> � <br /> REASON <br /> STATE BUII DING SURCHARGE ;(j U <br /> iNiAK[BY PUNSPPPROVEDBY CITY OF EVERETT PUBLIC WORKS ' <br /> LOCAL SALES <br /> o�,� TAX CODE IS 3105 TOTAL r I �� <br />