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�APPLICATIQ'� FOR COI�STRUCT���N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTI�IENT HEATING S`/STEM: '�GAS � ELECTRIC J � <br /> 259-8810 / <br /> � DEMOLITION ! ! COMBINATION I! BUILDING I I MECHANICAL ! ' PLUMBING SIGN <br /> o�LJCIY� 'f VIYC��(11C�'ni�nooa881�3 IU-1-h �,. 5. �. CveveZFf� �I�lU�HONE(2��) ��1�-133� <br /> � TEN4NT "U�1[IL O SS CITY 21P PHONE <br /> N) A '� � � <br /> �RGHITECiOfl�ESIGNEF MAILADDRE55 CI7Y ZIP FHOY@ <br /> nl�q � <br /> GENER4L CONTRACiOR IdAIL ADDRE55 CITV ZIP PNONE ST�TE LICENSE d <br /> IJ A <br /> h1EGHANICA(.CONTRACTOR MFILA��RE55 CITY ZIP PMONE STATELICENSEa <br /> NIA <br /> PWIA�INGCONTR�CTOR MMIADDRESS CITY ZIP PHONE ST�TELICENS'ea <br /> r��A <br /> CONTFAGT�i�FWOFK ��� — <br /> DESGRIBE WORN AND SOUAFE FOOTAGE INVOLVE� N1ACT PERSOt!AND PHOfJE NO <br /> CCrCiI(�1 <br /> �ad�i,+;�� — a� y s� . - � <br /> _ _ I 'iEtiEBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br /> PPOPOSED USE OF 9U�LDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �Jt�C��C�L:m I '�U'�`���1 �_ � PRGVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eca�oescv�FnonoFa oFeaTv�sHown ELOWOFATTAGHTWOCOPIeS) N10RK N'ILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i.or- !� e�ocK � oF m�u� ���n - AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �1P �� �1 f 1 \��(l. VU,U Yn� , L�S OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> '-'1 PERFORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> U� \ `U�s 1 OWNER G� THIS PROPEf�TY TO PERFORM THE WOAK FOR WHICH <br /> � �S ' �1 1 APPLICATiON IS MADE AND I COMPLY WITH THE STATE <br /> anacei rnx i .uurtieea CONTRACTORS LAW 18.27 RCW AND 290.200 WAC. <br /> - 3/U -�G > - <br /> CONSTRUCT'�ONLOANLENDER.ADDRESS.TELEPNONENUMBER �O ' � � <br /> �--� � �� � r-_ �_� <br /> P�J��I D �� `1 '� � ) �Ver�� s�c uae oaiE _. <br /> r, �-+•FJ, ci�vousrv[s�. usEno <br /> PLUMBING MECHANICAL _ <br /> NO. TYPE OF FU(TURE OR 7 E FEE NO. TYPE OF EO�IPMENT FEE <br /> WATER CLOSET(TOILET) A/C-A�HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. __�_ <br /> LAVATORY(WASH BASIN) UtJIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> —r <br /> DISHWASFIER RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATEF <br /> CLUTHES WASHER � WO�'JD STOVE �I <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREF'LACE INSERT � <br /> FLOOR DRA�N � HEAT PUMP ' <br /> RACKFLOW PREVENTERS GAS PIPING <br /> FlOOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETQ) ; _ .___ _ <br /> , � <br /> --i— <br /> i ' <br /> SUB TOTAL S ' SUB TOTAL S <br /> PERMIT S � PERMIT S <br /> TOTAL FEE $ ' TOTAL FEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> FRONfSETBAGK REAFiSETBACK � SI�ESET�ACK / PLANGHEGKNU616ER FEE � 'j�J AEGE�NO. � <br /> .� �3 � <br /> 7.� � <br /> usezoNe �ornaen vncnNrsire FEES VALUATION FEE <br /> � - I �� YES .�. NO OUi�DiNG �3,SZ '- <br /> ivPEaFcorl5l. No.oFS7oRIE5 occ:,�u,cr uoo�oWFwr„c�ns -`!— i <br /> n � � � �"�°�' � PLUMBING i <br /> SIZE OF�LDG. FIRE SPRINNLERS REOD �ASEMENT MECHANICAL � <br /> �a sr ra �i� __ YES ✓� — ; <br /> oCcuPnNCv�ono FIRE�L4RM11 REOD HEIGHT LIldITATION ADDITIONAL PLAN CHECK i <br /> � � ��(� � OTHER ' <br /> FEASON - � <br /> STATE 9UIL�ING SURCHARGE � <br /> WTAKEBY PLPNS�PO�BV CITY OF EVERETT PUdLIC WORKS <br /> LOCAL SALES � <br /> — DATE s�-� �y TAX CODE IS 3105 TOTAL i � <br /> — <br />