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APPLICATIOAFOR CONSTRUCTI&N PERMIT <br /> TO BE COMPLETED IN BLACK INF. PLEASE PRINT <br /> �r -7k)3 3 <br /> BUILDING DEPARTMENT HEATING SYSTEM: LyL;AS J ELECTRIC ] <br /> 259.8810 v <br /> ❑ DEMOLITION ❑ COMBINATION ,(BUILDING I MECHANICAL I ! PLUMBING I I SIGN <br /> OWNER MAIL ADDRESS �/��� CITY 21P PHONE <br /> 44/1) Aakl AP10,ko 1•a 'LA,C gd'c'L-,7 (o-N•,I-.;2..3 a-i <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY Zip PHONE <br /> G ERQ CONTRACTOR MAIL ADDRESS CITY ZIP PHOI+E STATE LICENSE F <br /> G a,S 6 2111 iYnT _ <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PROF IE STATE LK:ENSS A <br /> PLUMBING CONTRACTOR MA.L ADDRESS CITY ZIP PHONE STATE LICENSGI <br /> CONTRACT PRICE OF WORK <br /> DE6CRIBE WORK AND SOUAPEF TAGE INVOLVED C�EtI�TPERSON AND PHONE 00 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P OPOSEO USE OF BBUUILDINR _ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> C 'LG •� C.d -T !2 GG-. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAIL SCRIPTION OF PRO (SHOWN BELOW OR'ATTACH TWO COPICSI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOr�✓� BLOCK — OF /�ZY NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 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 /> P CEL TA%ID NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION I DAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> PROJECT ADDR saN.rwE '�I�- DATE <br /> 03- ST 'l✓ 9 CITY BUSNEOBS I.CEN NO -- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WAVER CLOSET(TOILET) A/C—AMNDLG UNITS—H.P. I <br /> �— <br /> _ 7 BATHTUB 71 FORCED AIR SYSTEMS—B.T,U. M E.A. ' <br /> LAVATORY(WASH BASIN)/,V UNiI HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS i I <br /> KITCHEN SINK 8 OISP �:,C VENTILATION FAN _ <br /> DISHWASHER I RANGE HOOD T <br /> _ LAUNDRY TRAY WATER HEATER ' <br /> _ CLOTHES WASHER I WOODSTOVE I <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ' <br /> _ FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN I <br /> SINK(SERVICE—BAR.ETC.) ' <br /> T <br /> I I <br /> I I <br /> I I <br /> I I <br /> _ SUB TOTAL S I SUB TOTAL S <br /> PERMIT 5 I PERMIT $ i <br /> TOTAL FEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> iR(kIT SETBACK Z REAR SETBACK� SIDE SETBACK 7[K Ad PLANCN KNUMBER FEE RECEIPT NO <br /> sem s� Z.S 5 �.s l 3 3 love. a3 9�1r 3 <br /> use zoL01 AREA�?� VACANT SITE FEES VALUATION FEE <br /> -S IZ,5bo El YES ❑ NO BUILDING 82 74 <br /> rvvE OF carsr No of—irsrq(IIEs axl ' "mu'""' <br /> _ �' G 1 PLUMBING <br /> Y.i1ZE&!. s f t FIRE SPRINKLERS RE00 BASEMENT MECHANICAL I <br /> - b:f17S7 ns G� D n YES i NO <br /> OCCUPANCY LQAO FIRE ALARM RED HEIGHT LIMITATION ADDITIONAL PUN CHECK <br /> OTHER ho ' <br /> REASON / I <br /> STATE BUILDING SURCHARGE uG <br /> INTAKE By PLANS APPFPVy BYFT, <br /> ITY OF EVERETT PUBLIC WORKS f— ' <br /> J LOCAL SALES <br /> DATE 3 / qX CODE IS 3105 TOTAL <br />