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APPLICATI��"1 FOR CONSTRUCT'�N PERMIT � <br />TO BE COMPIETED IN BLACK PNK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: �] GAS [j� ELECTRIC ❑ I <br />259-8810 <br />❑ DEMOLITION CI COMBINATION C� BUILDING ❑ MECHANIChL ❑ PLUMBING G SIGN <br />OWNER MAILAODRESS CITY ZIP PHONE <br />Tony Holganza <br />TENANT MAILAD�RE55 CIN 21P PHONE <br />Holganz.a Family <br />ARCHITECTOPOESIGNER MAILADDFESS CITV 21P PHONE <br />Steve lhomas 2630 116th Ave. N.E. Bellevue, WA 98004 206 822-8820 236:, <br />GENERALCONiRACTOR MAILADORESS CITY ZIP PHO4E STATELICENSEI <br />Bruce Prater P.O. Box 369 Hanesville WA 98340 'l06 568-6555 BRl10EP C08Rf'1 <br />MECHANICALCONTflACTOP MAILADDPESS GTY ZIP PHONE STATELICENSEt <br />PLUMBINGCONTRACTOF MAILADDRESS CITV ZIP PHONE SiATELICENSEI <br />CONTRACT PRICE OF WORK <br />S 2uo,000.00 �c:oa� as�35��� <br />DESCRIRi WORK AND SOUAFE FOOTAGE INVO��EU � <br />Construct a one story residence with finished <br />and garage area of : 648 s.f. <br />PRUP�',�•ED USF OF BUIIDING � ' ' <br />Single Family Residence <br />LEGAL OESCFiPTION OF PROPERTV ISHOWN BELGW OH A7�TACR T1Y0 COPIE!i� <br />�oT 68 K o_ Division 2 <br />Powder Mi`� Hiqhlands also known as <br />PARCEL lAX I.O. NOIdtIER <br />CONS'� RUCTION LOAN LENDEF. ADORESS. TELEPYIONE NUMBC-R <br />� PROJ CTADDflESS <br />�/� L- 55 �t%� <br />PLUMBIN� <br />N0. TYPE OF FIXTURI? OR REM <br />. ; WATER CLOSET (TOILEn _ <br />'��, BATHTUB <br />- � LAVATORY (WASH BASIN) <br />SHOWER <br />. TCHEN SINK 8 DISP � <br />i UR�NAL <br />� DRINKING F <br />I FLOOR DRA <br />BACKFLOW <br />' ROOF DRAII <br />� SINK (SERV <br />FOR OFFICE USE ONL.Y: <br />FFONTS�T6ACK HEAR: <br />��i <br />__� _S <br />TYP•E� O-yf �CON�ST. <br />�• �v <br />REASON <br />INTAKE BY <br />SUB TOTAL <br />PERMtT <br />TOTALFEE <br />NU. OF STORIES <br />� <br />FIRE SPR.IN1KLEHS iiEO'D <br />FIFEALR MREC'D <br />No <br />PLAN'i APPROVED BY <br />DATE n�lw IA2 <br />GONTACT PERSON AND PMONE NO. <br />Steve H. Thomas Y Ttiomas/Bordewick Architects <br />i HEREBY C[RTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAIdE TO BE TFUE AND CORRECT. ALL <br />PROVISIONS Q� LP.WS AND ORDINANCES GOVERNING 7HIS TYPE OF <br />WORK WILL BE CCMPLETED WITH WHE?HER SPECIFIED HEREIN OR <br />NOT. THE GP.AR�PNC OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHCriiT'f TO YlOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER �Tt.?E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER �F THIS ?RUPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STAT[ <br />CONTRACT�RS LAW iB27 FCW AND P96200 WAC. <br />/1�71, , . � ,r . _ .. <br />NO. I TYPE OF <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.I:. M <br />FAN <br />WATER <br />METAL FIREPLACEI <br />FbAEPLACE �NSERT <br />HEAT PUtAP <br />GAS PIPING <br />EXHAUST FAN <br />SIDESETB�• � / I P�N�^ N�� <br />00 <br />❑ vEs ❑ No <br />LUPANLY NJOiDWElLi9GUMrt5 <br />%M 1 I <br />❑ YES �(NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAl( CODE IS 3105 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER � �/� <br />STATE BUILDING SURCHAflGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT <br />TOTAL FEE <br />lv3 <br />$ <br />FEE <br />_ ' <br />. <br />