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APPLICATION FOR CONSTRUCTION PERMIT <br /> T7 BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> 259.8810 <br /> O DEMOLITION O COMBINATION BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAIL ADDRESSCITY •e <br /> 11 "ffl _/ <br /> TENANT MAIL ADDRESS CITY ZIP <br /> ARCHITECT OR DES@NEP MAIL ADDRESS CITY ZIP PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY 21P PHONE STATE LICENSE I <br /> �1tiLC. 4-S 47MTit l.+^ OCGA?'/2/DA'+S•T <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF WORK <br /> OE SCRIBEWORKANO AREF TAOEINVOLVED gsp�A�D`PHQNE NO. <br /> Ka�,o2a>L �-�-�u.' ryad EG I AS O rJNV __ G Sf 9 £1/SSl <br /> PROPOSED USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> t• !- APPLICATION AND KNOW THE SAME TO BE TRUE AND:(iRRECT. ALL <br /> m LGp'� OF <br /> PROP RV �l S'•''�CH _ PROVISIONS OF LAWS AND ORDINANCES GOVERNING (HIS TYPE OF <br /> LEGAL Of RIPnoN GP PROPEIVT IISHown BELow�oRj ATTACH/Tw�o��COPIE/,Ay/I1 .YORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT _ BLOCK OF /-LL-L']Qr1 /E1.1/r_ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> pi_ „/ �_ „/� �.1.•v Z AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 7YJ'�vcn.Lti'.Gi 4T OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Q n PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> .�/ f OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCEL TAKID HUMtlER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> _ O CONTRACTORS LAW 18.27 RCW AND 286.200 WAC, <br /> CONSTRUC TION LOAN LENDER.ADD RE .TELEPHONENUMBE / 8 <br /> 14�L .5 l 703 / 9 <br /> PROJECTADD ESS A�' ;2.4.2,04L— - <br /> CRBUFNESELCENSEHO <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM FEE NO. I TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I NC—A/HNDLG UNITS—H.P. <br /> Z BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. I <br /> PKITCHEN <br /> (WASH BASIN) IINITHEATERS—B.T.U. M ' <br /> CLOTHES `RYERS <br /> INK 8 DISP ' / VENTILATION FAN I <br /> RRANGE HOOD <br /> RAY WATER HEATER I <br /> ASHER WOOD STOVE METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS_ ; Z GAS PIPING 4 G5 r ci ' <br /> ROOF DRAINS—RAINLEAOERS I `T EXHAUST AN , <br /> USINK —BAR,ETC) ' <br /> I <br /> I <br /> I <br /> I <br /> SUB TOTAL $ ' SUB TOTAL $ <br /> PERMIT $ I PERMIT $ <br /> TOTAL FEE $ 1 TOTAL FEE $ I <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REAR SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USEFONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> 11 YES ❑ NO , <br /> MID <br /> CONStJ.OF STORIES woaMLlwc urin BUILDING Z - :1 , <br /> 2 11 PLUMBING i <br /> SIZE OF BLDG FIRE SPRINKLERS REDD BASEMENT <br /> 313(,. J" cv R K J ❑ YES NO MECHANICAL <br /> OCCUPANCv)OAD FIRE ALARM REO'0 HEIGHT LIMITATION/ ADDITIONAL PUN CHECK I <br /> I <br /> Q '7 lJ OTHER ' <br /> REASON , <br /> T <br /> STATE BUILDING SURCHARGE � <br /> INTAKE BY PUNS APPROVEDBY CITY OF EVERETT PUBLIC WORKS i <br /> �Jo LOCAL SALES <br /> DATE (, �-/ TAX CODE IS 3105 TOTAL <br />