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APPLICATIC^� FOR �ONSTRUCT"-lN PERIVIIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: I GAS ❑ELECTRIC ❑ _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION I I COMBINATION f I BUILDING �MECHANICAL f 1 PLUMBING ❑ SIGN <br /> OWNEfl MAILFDOFE55 CIiY ZIP PMONE <br /> c.� ,��R� �.��� P �tei��e �c� �C C�.� q�i�l 1��=�-�l cp c �, <br /> TENANT h1AILAD�RE55 CRV ZIP PHONE <br /> ARCHITECTORDESIGNER MAILADDRE55 CITY ZIP PHONE <br /> GENERALCONTHACTOR MAILAODflE55 CITV ZIP PHONE STATELICENSEC <br /> MECH4NICALCONiRACTOR MAI�AODRESS CITV ZIP PMONE SiATELICENSEn <br /> ��.g�, x��tn�.� Net-ttn0. I2-UZChe�!-t���l ��'EVer�t� �1��1 '�. �� 33L1�-I ��1�1�-��fCS-?qOl. <br /> PLl1A1BING WNTR�CTOR ILADORESS f,ITY ZIP PMONE STATE LIGENSE a <br /> �,rlYl c� <br /> COjJiRFCT PflIGE Of WORN <br /> �1 n ��n Q� D ��'� Il I ll (1CL.�� — <br /> OESCFIBE WOfiK AND SOUARE F TAGE INVOL D CONTPCT PERSON OND PHONE N0. <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USE Of BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPT�ONOFPROPERTV�SHOWNBELOWORATTRCHTWOCOVIES� WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK - OF AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFO!;IA THE WORK FOR WHICIi <br /> APPLICATION IS MADE AND I CO"�PLY WITH THE ST.4TE <br /> anece�Tnx i.o.NUMeea CONTRACTORS LAW 7827 RCW AND 29f.200 WAC. <br /> CONSTRUCTIONLOANLENOER.ADDRESS.TELEPHONENUtdBER <br /> PFOJECT ADDRESS �D P�s���n r�Jn.i,r��SYI �� / 9 _ <br /> s,c::,vunr ' re <br /> C�iv[US-k[55 LCE15[NO <br /> PLUM9ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> , WATEF CLGSET(TOILGT) A/C—NHNDLG 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 CLOTHES DRYERS <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL PIREPLACE�WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> --� <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ( (J ' <br /> � ! y�65 <br /> , � <br /> � � <br /> SUB TOTAL $ i SUB TOTAL $ /(J i � <br /> PERMIT 5 � PERMIT $ /5 � <br /> TOTAL FEE 5 TOTAL FEE S (�i ' � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAGY fiEAR5ET8FCK SIDESETBFCK PLANGMECKNUI}yER fEE AECEIPTNO. <br /> �L j 3 <br /> usezoNe �oTnnen vncar�rsiTe FEES VALUATION FEE <br /> �— <br /> �_' YES :� NO pUILOING <br /> iYPEOFCONS'. NO.OFSTOFIES Ocn�r„.gy i,oC�c'n[�.w��cunn5 <br /> ceau� PLUMBING i <br /> SRE OF BL�G FIPE SPRINNLERS REO'D B45EGENT ��tECHANICAL � �� <br /> �l YES �:—i NO <br /> OCCIIPANCYLO�D FIREALqRMREO'U HEIGHTIIIAITM1?IGN ADDITIONALPLANCHECK <br /> OTHER <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> - ' i <br /> INTAKE�Y ALANSAPPFOVEO BV CITY OF EVERETT PUBLIC WORKS � <br /> LOCAi.SALES <br /> onr� TAX CO�E IS 3105 Tov+� <br />