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APPLICATIQ' ' FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8610 <br /> i 1 DEMOLITION I 1 COMBINATION u BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADDFE55 CITY ZIP PNONE <br /> � n�YII/M(/A1 <br /> TENRNT MA.�4DDRE 5 CITY ZIP PMONE <br /> J <br /> AqCHItECTOR0E5 NER MAIL ESS CITV ZIP PHONE <br /> GENERALCO4TRRCTOR MAILAODRESS CITV 21P PMONE SiA'ELICENSEII <br /> MECMANICAL CONTRACTO MRIL ADDFESS pTV ZIP PHONE STATE LICENSE� <br /> C�+�e�� � c3ox isaa ta,c�F Yszo c zsz-.3��4 c-v-�-6s.�zl,�e� <br /> PLUMBINGCONTRAGiOR MRILAD�RESS CITY ZIP PHONE STATEIICENSEY <br /> COI ITRRCT PRICE OF W(�( <br /> Jl � �,� <br /> DEuLRIBE WORK AND SOUAPE OOTAGE INVOLVED WNiACT PERSON AND PHONE N0. �j <br /> ��.1' L.�C- <br /> ,��xtt_ � c.ax.C. QD�s � <br /> i HEREBY CERTIFY THAT � HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF BUILDING,t�/y� APPLICATION AND KNOW iHE SAME TO BE TRUE AN�COFRECT.ALL <br /> (�'�TC{T PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LF.GRL�ESCRIPTIONOFPROPERTY�SHOWI.BELOWORATTFCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 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 /> PARCEL iA%I➢.NUM9ER CONTRAC70RS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRl1C.lON LOAN LENDER.AD�RE55.TELEPHONE NUTA9EN / /� �'�Q � ��� <br /> K �rcG <br /> X <br /> PROJECT ADDRE S swrv�rune o�rz <br /> CI1Y BUSMf55 UGCNSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) � A�C—AIHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASW) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRY[RS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING F'�UNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADEFS EXHAUST FAN <br /> SINK�SERVICE—BAR.ETC.) <br /> — I <br /> — ; <br /> — �— <br /> SUB TOTAL S SUB TOTAL $ <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTALFEE 5 J ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAGK F[ARSEIDACN Slp[SEi�ACK �L4NCRF.CKNUMOER FEE RECEIPTNO. <br /> useioru[ �oraaen VPCANTSIiE FEES VALUATION FEE <br /> . 1 YES ��� NO p��ILDiNG <br /> iYPCOFCON51. NO.OFSTORiES oi[uPevw xoaou'tu�xGu�inS �-- i <br /> �PW° PLUMBING i <br /> 512EOFBtDG. FIRESPRINNLERSREO'D BASEMENT MECHANICAL <br /> � � VES .�_ NO <br /> i <br /> OCCUPFNCYLOPD FiqEAL�RIdREO-� HEIGHTIIMITATION ADDITIONALPLANCHECK <br /> OTHER <br /> ilEA50N <br /> STATE BUILDtNG SURCHARGE <br /> ���r�����—-- rin�us nvanoveo ov CITY OF EVERETT Pl1BLIC WORKS <br /> LOCAL SALES <br /> �A,F TAX CODE IS 3105 roTa� <br />