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APPLICA�10!''� FOR CONSTRUCTl��N PERMIT � <br /> TO BE COPAPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS CI ELECTRIC U � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION i:] COMBINATION �BUILDING Ci MECHANICAL I 1 PLUMBING U SIGN <br /> � N� lAAIL�OUf1ES5 CITY ZIP PHON� <br /> � bo� tilY��� QQ��.rnn�;,�� Wa �1�D3Z���- 7 � • ►�33_ <br /> tEnnHi Mnf.Annncc. CITY � ZIP P��ONE <br /> �CHR[�GT yFDESIGNEP MAILRDDRE55 CITV 'I ZIP PHONE <br /> JQCns� II1Drnflg���l�l �n��'�_�'��aL�1-lo)a 9�'20) �?oG�,�s�-9?B� l��u]��s5'ien �s�'�-._ <br /> GCt1FRnlCONT A R IdAL�D RE55 QTY IIP � PIIOHE S7A UCENSE�T <br /> �r �1�� _ ��-T��_lold��k��R� L�j�o�� ��.o6��Y3-�{�E.(z�KJ��a7�Rs <br />' IAECHAl11CALCONTRnC"iOR MAiLA00RE5S CITY ZIP P110NE STATEUCENSEI <br /> PLUTABINGCONTRACTOR MAILpDDFcSS .^.RV .'lo PHONE STATELICENSE! <br /> GONiRAGT PPICE OF WORL' f <br /> OESCRIBE WO AR�SOUAFE OOTA INVOLVEO ����j�{Q� CONTACT PERHON ANO PHONE NO. <br /> �� 3�. II���0 S��(4�~—�++4� <br /> �i /I _ <br /> 7'l Il.L� ,�9C1�P�1Y,n'#'ar�r� C[t�?�M i HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF i DING AP?LICAI IOIJ AND KNOW THE SAME TU BE TRUE AND CORRECT.AI.L <br /> �'��.. 'l � <br /> ,m t �� ..Q..S 1 [ D PROVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TVPE OF <br /> iecn�o '�c]RIPT� N2F,r,ao�'�ow�seJ.owoa�Npryoc�/� �� WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> LOT / �9LOCK � OF" �` � n� r b ° NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> b� r � 1� I,� L ��� �� '�j AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP ANY <br /> �1nRe1'b4 SrL �� U.il r����C o�_�C` p�EFiFORMANCEOOF OONSTRUCTION.T4AT I AM AUTHORI ED BY THE <br /> p�� ��F , �,�,y� _ V _ _ _ –__ OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br /> T�� ��' 1 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCE^TA%I.D.NU�ge�ea CONTRA TORS LAN'78.27 RCW AND 296.200 WAC. <br /> � 75 � 7�"O��O-Oo -'COp� �, <br /> WNJiM CTIO LOANIENDER.AODRESS.TELEPHONENUM E ------_- . 1��� <br /> . � � ._,��¢ , ti�' l �?z -���.�-�44 <br /> PROJECT A DR SS s�cHnr e o�te i <br /> • 2 � ' CItYBU3ME55UCEN5['q � <br /> PIUMBING MECHANICAL <br /> N0. TYPE OF PIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE _ <br /> � 3 WA?ER CLOSET(TOILETI AiC—A/HNDLG UNITS—H.P. � _ <br /> BATHTUB FORCED AIF SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> �0 SHOWER _ ' CLOTHESDRYERS ' <br /> �_ <br /> KITCHEN SINK&DISP ; VENTILATION FAN ' <br /> �- <br /> DISHWASHER � ;iANGE HOOO _ � <br /> LAUNDRY TRAY N'ATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL McTAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN F IREPLACE INSERT �_ <br /> FLOOR DFAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> 51NK(SEFJICE—BAR,ETC.) � <br /> � � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL S ; <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: I <br /> FRONTSETBAC% RFARSETBAGK SIDESETBACK � / PL�NC�IE��w•1BE}i FEE �� RECEIPT O�..{�Z <br /> � / � �f C!!� ✓ <br /> USE ZONE LOT AREA J� VACANT e FEES VALUA ION FEE I <br /> �"S� I � OC/ �l YES �I NO BUII DING / 3 � ' I <br /> 1YPE plC0�I7 NO.OFSTORIES otfUvevcv xO.nrUvttt'.�i�Gw�us , /�� i <br /> ` /� ��_�� PWMBING ��� � � <br /> �� �J� r <br /> SREOFB OG FIREiPRINKLER5RE0'D BASEMENT MECHANICAL I (J� � <br /> ZJVL ! �d [7 YES f ! NO n���/// j „))) <br /> OCCUP 'CV LO�D FIRE AL�RM REO'D HEIGMT LIMiTATIDN ADUITIONAI PLAN CHECK � <br /> 1 n i <br /> _�� I � OTHER �(�' � <br /> T <br /> REASON i <br /> STATE BUILDING SUFiCNARGE , <br /> INTnKE BV PLANS RP�OVEDBV CITY OF EVERETT PUBLIC WORKS 2 D� <br /> J LOCALSALES <br /> U�TE c� TAX CODE IS 3105 TOTAL 3' ��0 ., <br />