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APPLICATICQ FOR CONSTRUCT1IN PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � rTET <br /> BUILDING DEPARTMENT HEATING SYSTEM;I XGAS U ELECTRIC U <br /> 259-8810 <br /> 11 DEMOLITION COMBINATION Ll BUILDING IA M,_CHANICAL ❑PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> /� Teo yp�,1 5 ink I R`ll3 fn -EJI Nwt p ysol <br /> E[T/E�N�AN'T MAIL ADDRESS CITY ZIP PHnNE <br /> SARCHITECT OR�DESIONER MAIL I���S� G�jC CITY ZIP <br /> a PIwNE A1/�O <br /> (E lFu 5 SVS S�1F1T ?a A11:70 ig- <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE TATE LK;ENSE9 <br /> METCU f-(DdIFS 'Tay Y. <br /> MECHANICAL CONTRACTOh MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF WORK --- <br /> DESCRIBE ORK AND AR T E INVOL s CONTACT PERSON AND PHONE NO <br /> �L/8 Liv; At Ad /AIE+EI (�� <br /> Z - HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnNG--- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL �I <br /> p PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DESCRIPTION Of PROPERTY(SHOWN BELOW OR ATTACH TWO COPIE SI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR •' <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCK F AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUM9ER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,ADDRESS,TELEPHONE NUMBER � <br /> PROD CT ADD E S - _ W „ TE <br /> 1 /"AfuR� wTE 'AAr/7' <br /> CITY BUSWESS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) - A/C-ATHNDLG UNITS-H.P. <br /> BATHTUB - FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN)4- I UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS it ' <br /> KITCHEN SINK 8 DISP - I VENTILATION FAN <br /> DISHWASHER RANGE HOOD ' <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER - ' WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING( ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERa$ : <br /> GAS PIPING - <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.( <br /> SUBTOTSUBTOTAL S <br /> PERMIT PERMIT E <br /> TOTAL FETOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PLAT..nB KNUMBER FEEyA RECEIPTNO^ <br /> USE ZONE LOf AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO ` 2 / <br /> BUILDING <br /> TYPE Of CONST NO OF STORIES Bc NA "AIwTAMIFRA I <br /> p141p Z PLUMBING i <br /> SIZE OF BLDG FIRE 6PRINKLERS REOD SASE ENI MECHANICAL , <br /> 41zc' A" ❑ YES X NO <br /> OCCUPANCY LOAD FI•IE ALARM REO'0 HEIGHT LIMITATNN! ADDITIONAL PLAN CHECK <br /> %ft r <br /> liJ'� OTHER I — <br /> REASON <br /> A7ry�A I Vy. STATE BUILDING SURCHARGE <br /> INTAKE.BY /�T"T•�L/ PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS i <br /> JM LOCAL SALES —�—_ <br /> DATE V&ltjo TAX CODE IS 3105 TOTAL 02, <br /> r <br />