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APPLICATIC 1 FOR CONSTRUCT' )N PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT �- <br />259.8810 <br />❑ DEMOLITION LI COMBINATION <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />17 BUILDING <br />MECHANICAL <br />❑ PLUMBING 1 I SIGN <br />"MV T*LAr/iff <br />v -r3 <br />MAIL ADDRESS <br />.vL._., <br />CRY' <br />7�,acfD .56�7-�j3S�1 <br />qP p110NE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP PHONE <br />PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICENSE A <br />CONTRACT PRICE OF WORK <br />coo <br />CF I NVOLV <br />CONTACT PERSON AND PHONE NO <br />L4" (�'�'�+� ' <br />,PROPOSED <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PgoPosEo USE of BUILDING <br />S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />OF PROPEFfoLEGAL DE IPTIDN OF PROPE <br />ErIPTIDN ISNOWN BELOW OR ATTAC D IES) <br />WORK WILL. BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />I/� <br />P-� b"y md'a - �(r% <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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PA EL TAKID NUMBER <br />0 7 — <br />CON ACTORS LAW 16.27 RCW AND 296.200 WAC. <br />CONSTRUCTIONLOAN LENDER, ADORE BSPP, 32 R <br />SP 32 <br />x <br />PROJECTADURESS <br />-- <br />tnr BlSiwras, rr Nsr Hb ' <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—A/HNDLG UNITS—H.P. <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. ME <br />, <br />, <br />LAVATORY (WASH BASIN) <br />Ti — <br />UNIT HEATERS—B.T.U. M <br />' <br />SHOWER <br />CLOTHES DRYERS <br />, <br />KITCHEN 8 DISP <br />; <br />VENTILATION FAN <br />RANGE HOOD <br />I <br />HS'NKER <br />DISHWASHER <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />r <br />CLOTHES WASHER <br />, <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />, <br />DRINKING FOUNTAIN <br />' <br />FIREPLACE INSERT_ <br />I <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />, <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />r <br />ROOF DRAIN^,--RAINLEADERS <br />I <br />EXHAUST FAN <br />, <br />1 <br />r <br />, <br />T771E <br />r <br />' <br />SUB TOTAL$PERMIT <br />S <br />' <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SEi�', <br />Z <br />REAR SETBACK, <br />SIDE SETBACK / <br />PLAN CHECK NUMBER FEE <br />RECEIPT NO. <br />�'J/ <br />8, 50 <br />�9 <br />USEZONF <br />LOT AREA <br />VACANT SRE <br />FEES VALUATION <br />FEE <br />Z <br />11 YES ❑ NO <br />BUILDING <br />' <br />TYPE Of CONST <br />7Z. OF STORIES <br />otRmM.r <br />Mo gPMNMA UAirs <br />PLUMBING <br />i <br />tAaur <br />SME OBLDG <br />FIRE SPRINKLERS REDID <br />BASEMENT � <br />MECHANICAL <br />- - --�—� <br />0 <br />❑ YES YNO <br />r <br />ANCYL AO <br />fF <br />FIRE ALARM REOU <br />HEIGHT LIMIT/LTION <br />ADDITIONAL PLAN CHECK <br />O <br />r <br />' <br />OTI4ER <br />REASON <br />STATE BUILDING SURCHARGE <br />' <br />INTAKE BY <br />MANS D BY CITY OF EVERETT <br />UpLOCAL <br />PUBLIC WORKS <br />-J�fl' 3G <br />SALES <br />TOTAL — <br />5� <br />DATE (p /Zq 43 TAX CODE IS 31G5 <br />