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APPLICATIC" 1 FOR CONSTRUCT"11N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT <br />I HEATING SYSTEM: U GAS !J ELECTRIC —� <br />259-8810 <br />DEMOLITION I-i COMBINATION 11 BUILDING i; MECHANICAL L I PLUMBING I SIGN <br />OWNER A0. ADDRESS CITY ZIp PHONE <br />MAuce `/Rzo> �oCr� 9y -3l <br />... r. T ZIP PHONE <br />ARCHRECTORDESIONER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENEFKCONTRACTOR <br />MAIL AOMTEiS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSEE <br />oFLIVLQ(' <br />MECHANICAL CONTRACTOR <br />MAP ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STALE IK:ENSEI <br />PLUMBING CONTRACTOR <br />MAP ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF INO% - m n a <br />U <br />DFBCRIBq�W(11 OBAPo: FOOTAGE INVOLS D ) <br />I(�� ((��7�T <br />fAN�CT PEU SQL! ANO P1pNC 1qS. 1 ,j <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PR o InF a BunowG <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY!SHOWNSELONORATTACH TWOCAPIESI <br />OU <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />OF ANY <br />LOTS BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS <br />^ <br />n�� �Z_, <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />V I - <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF TOWHICH <br />THEOH KT <br />_f <br />_bL"e �02- piZ� <br />co - r+ <br />APPLICATION1 ISROPERTY MADE A DPI COMPLY WITFORM <br />ER STATE <br />CqNTR4CJORS LAW 18.27 ROVIND 296.200 WAC. <br />PARCEL TAX I O NUMBER y,- -n.L IOU t O L. T' I) <br />CONSTRUCUONLOANIENDER ADDRESS TELEPHONENLMBCR <br />PROJECT ADDRESS BB ' II <br />L.U/— <br />c..mKm. ssl Klv✓r <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EOUIPMENT FEE <br />WATER CLOSET (TOILET) <br />AC -A HNDLG UNITS-H.P <br />BATHTUB <br />___ <br />FORCED AIRSYSTEM5-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />�_— <br />J_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS _ <br />r— <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />�_ <br />RANGE HOOD _ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />L- <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />�_ <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEAUI RS <br />__- _ <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.I <br />-- <br />-- <br />SUB TOTAL f <br />SUB TOTAL f <br />- <br />PERMIT f <br />--r <br />- PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />I oh OI 1Ict_ U ;1. UIII <br />USEZONE LOT AREA <br />TYPE or CART NO. OF ST <br />SIZE <br />PLANS APPROVED PY <br />RATE <br />11 YES :: NO <br />BUILDING <br />'- <br />PLUMBING <br />MECHANICAL <br />- <br />IXOFM[t <br />CAM <br />MI tlONiIIM.uVN <br />BASEMENT <br />I 1 YES ! NO <br />14FK:IHIIMITATIM <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS3105 <br />-- <br />ADDITIONAL PUN CHOCK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TorAl <br />11f nFCFIPTW <br />VALUATION FEE <br />I <br />i <br />i <br />9 <br />