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APPLICATIO'` FOR CONSTRUCTI~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 /> i 1 DEMOLITION !J COMBINATION � i BUILDING �VIECHANICAL I PLUMBING � i SIGN <br /> OWN � / / hIN�ADDRE55 CITv �— ZIP n PHONE <br /> l'c�u O ;Cil�%cc,�`�i� ��l /.(,�Lr C .�('�L i'6/� / <br /> TENAIQ M�I�pDDRESS CITV ZIP PHONE <br /> APCHITECTOROESIGNER MAILADDRESS GITV 21P PHONE <br /> GENERnLCONTRACTOR MAIL�D�RE55 CRV ZIP PMONE STATELICENSE• <br /> lAECHr�EIIpq�CONTRACTOR AIAILADDAE55 CITV 21P PMONE SiATELICENSEY <br /> I7�S �YC S /,(�.(5� <br /> PWIdBINGCONTRAG OR MMLADOFE55 CITV 21P PHONE STATF.LICENSEM <br /> GONTR..CT PRICE OF WORK <br /> DESCRIBE 1VORK ANO SOUAFE FOOTAGE INVOLVED COYi�CT PERSON AND PHONG NO. <br /> 1 ^ /.� / <br /> /� /L �lXn✓ � /i(G7 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SHOYIN�EIOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR i <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE �' <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnace�Tnz i.o uun+oea CON7RACTORS LAW 7827 RCW AND 296200 WAC. <br /> CONS'ROCTION LOAN LENDEF,ADDRESS TELEPHONE NUMBER <br /> � PROJECT ADDRESS " sw�+n _ � • osic T"— <br /> C �'� arveusia�ssuc ervo �� <br /> PLUMBING i MECHANI <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—AMNOLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD T— <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAM <br /> SINK(SERVICE—BAR,�TC.) ; <br /> � i— ( —''-- <br /> r �t2 J <br /> � — <br /> � � <br /> SUB TOTAL 3 ; SUB TOTAL $ ; <br /> PERMIT $ PERMIT 5 � <br /> TOTAL FEE $ TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBALK REARSETOACN SIDESETBACK PLFNCHEGNNOMBEfi FEE RECEIPiNO. <br /> usezor+� iornaen vacnNrsrte FEES VALUATION FEE <br /> -�. YES :; NO pUILDING � <br /> IYPEOfWNSi. NO.OFSiORIE'i MCu"a�dr AO�fONFlIitiGUNitS <br /> p°°tl� PLUM�ING i <br /> S2ECF�LDG. fIRESPRINKLER5RE0'0 B�SEMENT MECHANICAL � <br /> �-, YES �^' NO , <br /> ADOITIONAL PLAN CHECK �J`� <br /> OCCUPANCVLOAD PIflEALARMREOD NE�GHTL:MIiAiION ✓` " � /J <br /> _ OTHER �2t,t/G�l.� ���� ' �� <br /> RE�SON � � <br /> STATE BUIL MG SURCHARGE <br /> INTAN[f1Y PL�NSAPPROV[DDY CITY OF EVERETT PUBLIC WORK$ � <br /> LOCAL SALES <br /> oATE TAX CODE IS 3105 TOTA� <br />