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APPLICATIC I FOR CONSTRUCT )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM J GAS J ELECTRIC J <br />BUILDING DEPARTMENT — <br />259-8810 <br />DEMOLITION COMBINATION <br />OWNER MAIL ADLTRESS <br />DESIGNER <br />BUILDING MECHANICAL PLUMBING SIGN <br />CR__ _xn.. S <br />Y ZIP II NE � 1 <br />(� CITY ZIP PHONE <br />CITY ZIP PHONE <br />If <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br />CONTRACT PRICE OF VIpi1K <br />15'6 o . o a %40 <br />DESCRIBE WORK AND SOUARE FOOT^^E INVOLVED <br />CONTACT PERSON AND PHONE NO <br />�. q-a(-7q <br />,4 a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LEGAL DESCMPTI NOF PROPERTY I��LO �TT_C�L+ ";�Lj /1 /J <br />{/[19 —iJ / <br />BLOCK OP <br />NOT. <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LotIII— <br />/ �� <br />G`A <br />OTHER STATE OR LOCAL LAW REGULATING CONS) RUCTION 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />PARCEL TAXI D NUMBER <br />U <br />CONSTRUCTION LOAN 1 ENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE` MTf <br />PROJECTADD <br />)/ qa��-S� s. <br />CIfNATURML99lICl.N9! NO <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />WATER CLOSET (TOILET) <br />AiG—AMNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—S.T.U. M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) I <br />UNIT HEATERS—B.T.U. M <br />' <br />CLOTHES DRYERS <br />SHOWER <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />DISHWASHER <br />; <br />WATER HEATER <br />LAUNDRY TRAY <br />' <br />WOOD STOVE <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />FIREPLACE INSERT <br />' <br />DRINKING FOUNTAIN <br />I <br />HEAT PUMP <br />FLOOR DRAIN <br />; <br />GAS PIPING <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUST FAN <br />I ' <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />1 <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />P <br />' <br />PERMIT $ <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: E RECEIPT <br />PLAN CIIEGR flUMBER/ FE(v , O <br />FRONT SETBACK / REAR SETBACK SIDE SETS / U <br />VACANJN ITE FEES VALUATION FEE <br />USE Z E LOT AREA <br />,r ES NO BUILDING EONX <br />NO OF STORIE6 nccu��Na en a�rw[uws uMrs ' <br />TYPE DpIFCONS7 PLUMBING ' <br />SWDG FIRE SPRINKLERS REDO BASEMENT MECHANICAL ; <br />L�L`^A�11`•'•) - YES NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE ALARM REDO HEIGHT LIMITATI7 <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />__[_INTAKE BY PLANS APPROVED 61 CITY OF EVERETT PUPLIC WORKS O ' <br />LOCAL SALES <br />DATL <br />TAX CODE IS 3105 TOTAL <br />