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APF�"LI�AYIC 1 F9R CON�TI�UCT� )N PERl1A1'T � <br /> TO BE COMPLETED IN BLACK I�K—PLEASE PRINT <br /> HEATING SYSTEM � GAS iJ ELECTRIC ❑ -- <br /> BUILDING DGPARTMENT <br /> 259-8810 <br /> '� .MECHANICAL Cl PLUMBING LJ S1GN <br /> I DEMOLITION i i COMBINATION I i BUILDING pHONE <br /> �.,,—���E� M41LA�OiE55 <br /> CITV Z�P <br /> C - � y� � �O�O�U -�CZly ,r6� , � Lf1f-H �/��J�U ���U�n�3 <br /> )C I��I I� f'1� ���nJ CITV ZIP —��'HONE <br /> TLIJ�NT MAILFDORESS <br /> V�T� Z�p PHONE <br /> nFCllll[CT OR DESIGNEii IAAR ADDR"c55 <br /> CITV 21P PHONE STFTEJC[NSEt2,n�. %� 1�� <br /> GEt1ERALCONTR�CTOR MAILAD�FESS �– / ��� <br /> ��u) �i'rr 'tn�, l�������n rl�Qr��Pn) �ioNi����� � � �'a�or� ��7r� .,� - - <br /> ��TY �p PMONE STATE LICENSE a <br /> 'lECHANIC�LCONTR�CTOR � IAAILADORE55 <br /> ��T� Z�p PMONE STATELICENSEb <br /> PLIRABINGGONTR4CiOR MAILAODilE55 <br /> GOFITRACTPRIGEOFWORK �O <br /> �'��� COtlTAGT PERSON ANJ PHONE N0. <br /> DESC E YlORH AN S IJARE FOOT! E INVO ED r _ <br /> — , , � ,n — <br /> � i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PnoPoseo OF 9UIL�ING l�.z��— APPLICATfON AND KNOW THE SAME TO BE'(RUE AND CORRECT.ALL <br /> / PROVISIONS OF LAWS AND ORDINP.NCES GOVERNING THIS TYPE OF <br /> � ' 1VORK WILL BF COtv1PLETE'�� WITH WHETHEF SPECIFIFD HEREIN OR <br /> �ecn�oes a� TIONOFPFfPERTY�SHOWNBELOWORA'TAGH?WOGOPIES� NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK - Cf AUTHORIIY TO VIULATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMAIJCE OF CONSTRUCTION.THAT I AM AUiHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnRCE�rnxio Nun+ee� CONTRACTORS LAW 1E127 RCW AND 296.200 WAC. <br /> �ri-7��C�-f� C�-L'�lJB (�^,–/� �� / , `� <br /> GONSTHIICT10N LOAN LENOER.ADOFE55,TELEPNONE NU�ABER y �'�.���'/I������/'� ``�` �-�� <br /> } �r L .N 1 <br /> � o/.rE <br /> �"` ���IA�URC <br /> PRO��\/nD��ss�1�� �'11.� ` ��) rirvn�,���..��ssiicEr�sFr�o <br /> PLUMBING MECHANICAL — <br /> N0. TYPE OF FIXTURE OR ITEM <br /> FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�'C—A�'HNDL�UNITS—H.P. <br /> BATHTUB f FORCED AIH SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) _ � _ UNIT HEATERS—B.T.U. M ' <br /> _ � <br /> CLOTHESDRYERS � <br /> SHOWER . VENTILATION FAN <br /> KITCHEN SINK&DISP RANGE HOOD � <br /> DISHWASHER � WATEA HEATER <br /> LAUNDRY TRAY WOOD S�i OVE ' <br /> CLOTHES WASHER , METAL FIREPLACE(WOOD BURNING) T— <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN HGAT P�MP � <br /> PlOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTEFS EXhIAUST FAN � <br /> ROOF DRAINS—RAWLEADERS _ � � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � , <br /> — __� <br /> SUBTOTAL S ___ SUBTOTAL 5 � � � _ <br /> PERMIT S � <br /> PERMIT S TOTALFEE 5 _h,y_ <br /> TOTALFEE S - <br /> FOR OFFICE USE ONLY: aeceiP�No <br /> P�nuciiECKr:ur.+sEn FEE <br /> FRONTSETBACK REARSETBAGK SIDESET9ACK �/ – <br /> FEES VALUATION FEE <br /> IISEZONE LOTAPEA VACANiSIiE � <br /> ❑ YES !_�. NO BUILDING �-- <br /> tY7E0FCON5i. NO.OFSTORIES acuonur •�Oc�?r.[ui'•��'�'��s — <br /> �4��v PWMBING <br /> SIZEOF�IDG. FIflESPRINNLERSFEOD BPSEIdENT MEI�HPNICA� <br /> '_� YES :�- NO ---" <br /> OCCUPANCY LOAU HFlE AIARM REOD HEIGHT UM1IITATION <br /> ADU�T,ONAL PLAN CHECK �__ <br /> OTHER ' — <br /> REASON STATE BUILDING SURCHAFGE <br /> INTpN[OV PLANS APPflOVE��Y CITY OF EVERETT PUBLIC W�RKS <br /> LOCALSALES ; <br /> DFTE <br /> TAX COUEIS 3105 roTa� <br />