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APPLICAT10�1 FOR CONSTRUCTION PERMIT � <br />TO BE G..MPLETED IN BLACK INK—PLEASE PRIi. � <br />HEATING SYSTEM: ❑ GAS U ELECTRIC U <br />BUILDING DEPARTMENT - <br />259-8610 <br />I i DEh10LITI0N I I COMBINATION Iu�BUILDING It�fM�:CHANICAL C�YPLUMBING I I SIGN <br />OWNER IAAILADDRESS n QTV ZIP PHONE <br />� ID�-ScI?UGk �s�ai-�Knn�/� �IG� Sr/oF• Ge1A- I.S,r�%�% .33��OKilJ <br />TENANTI M1fAILnD�BESS QTY 21P PHONE <br />ARCMiTEC70RDESIGNER MFIL��Oflh55 GTY 21P PMONE <br />GENERALCONTFACTOR MAILADDRESS CITY ZIP PMONE STATELI�ENSEI <br />� -S�f,��� isna�•�K ir��,�cc l�� S„ah c.,� ���-,� 33�/•U8/7 RAI„NS oG�MI <br />n�ec�+n ,ca�co� NTRACTOR 57MS ADPeti� (�r. C3wtQ.%,y r� Gu/1 ��o��J' %3 :� �'a % 11 k5FEl1 .+�iA <br />" ;�o E+ C� <br />,i�� v , iY� <br />PIUMBINUCONTRACTOR MAILAD�RESS QTY ZIP 1'HONE STATEUCENSE> <br />? :�,., ;.�„ '�L. <br />CONTRACT PRICE OF WORK <br />JES�PIBE <br />PADPOSEGU EOFBW�DING �y✓ � <br />(ir.I 'C.O ./ o -1) - <br />LEGFLOESGBIPTIp OFPROPERTY�SHI <br />LOT� BLOCK — <br />PARCELTAXID.NUMBEfl <br />CGNSTRUCTIONLOAN <br />� G.0 %�1... h[ <br />INVOLVEO <br />Lc.rp o <br />LOW Ofl�AT/TA�CM .TW(,�O COPIES� , 1 <br />GF J�- �—�—�— <br />PROJECT ADDRESS �- <br />///c� i7'� � � UJ <br />PLUMBIh'G <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />a, `NATER CLOSET ('OILET) � <br />� BATHTUB <br />�, LAVATORY (WASH BASIN) � <br />SFIOWER ! <br />KITCHEN SINK 8 DI <br />DISHWASHER <br />LAUNDRYTflAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FROlj,,,^iETBACK �� REAR: <br />��?v3P� <br />TYPE OF CONSi. <br />� <br />SIZE OF BLDG <br />�,�$�t SF -1 <br />A153 5� � Gk/ <br />OGCUPANCVLOAO <br />N/A <br />REASON <br />INIAKE BY <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />Gsa��i,� � Fv�r-, �p 13a <br />CONTFCT PERSON FNO PHONE N0. <br />I HEREBY C'cR'fIFV THAT I HAVE READ AND EXAMINED TNIS <br />APPLICATION AND KNpW THE SAME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPFCIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANt <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMFNCE OF CONSTRUCTION. THAT I Ald AUTHORIZED BY THL <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICh <br />APPLICATION IS MADE AND I COMPLY WITH THE STAT[ <br />CONTRACTORS LAW 18271�CW AND 2962U0 WAC. <br />X ��`�0.1'/1 �G�'U^-t�-_ o�- - � - i �J <br />sicnemee J o��� <br />CI�T OUSIN655lICENSE NO <br />p. TYPE GF E�UIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. � <br />� FORCED AIP. SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN ' <br />� RANGEHOOD ___ <br />WOODSTOVE � <br />METAL FIREPLACE (W07D Bi1RNING) <br />� FIREPLaCE INSERT <br />� <br />HEAT PUMP � <br />; GAS PIPING ' <br />r 2 EXHAUSTFAN � <br />SIDE.^�§�Lfs n�/ � PlA � /GN <br />� % C � 7, V <br />LOT AREA VACA�IT SITE FEES <br />273 � YES ❑ NO BUILDING <br />1 OFSTORIES or,tur<stv Mo':a�ittuxGurd�s <br />� 1 �'3 i PLUMBING __ <br />FIRESPRINHLERSREO�D DASEMENT MECHANi�AL <br />�.� '-I YES ,-�O - — <br />FlREAlaR1AFW'D NEIGM%TU�TAITHTION' ADDITIONFLPLANCHECK <br />"v / OTHEF <br />STATE BUILDING SURCHARGE <br />PLANS �PPPOVED BV CITY OF EVERETT PUBLIC WORKS <br />Jid' LOCALSALES <br />DATE 7/4 �9c TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PEAMIT S <br />TOTAL FEE S ! <br />FEL � FECEIPTNO. <br />J _7 �/''."' � <br />S I f3'3Z <br />