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APPLICATIQ"�: FOR CONSTRUCT'lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i� DEMOLITION ❑ COMBINATION 17 BUILDING ❑MECHANICAL G PLUMBING ' SIGN <br /> OWNER MAIL ADDRESS GITY Z�F PHONE <br /> �oB�� r �: s,eowK ��a3 Zo� S� c- ✓ 9P�or 33�{-795y <br /> TENANT MAIL AODRE55 � GN ZIP PHONE <br /> /�E Kc4 X a?r'//7 �Q��/ti . -1�P«D/ �/S/— �5�� <br /> ARCNITELTORDESIGNER MAiLA�JORE55 LIiY 2iP PHONE <br /> ../r�/-�. / �,D � •,•�. � • S�Da Da.wri.w Fi� iYOzO 7 7S-OS� � <br /> GENERAL GONT ACTOR MAIL A�DRESS—� Y ZIP PHONE STATE LIGENSE 1 <br /> �.e�C.. l�C.u�c.u.e/ C'i„u� �23 2. �.e.:� �• ,� 1�,Q.-�w�� l`�27�0 <br /> EGMFNIGAI.GONTRFCTOR MAIL AODRE55 GITY ZIP P40NE STATE UCENSF� <br /> 6�22�_� ' �-�-f ��2=(Q.wct'`'a�' �° DQ..o�,�,,.. Q92Z(. <br /> PLUMBIUGCONiPACTOP IARILADD E55 CITY P PHONE STATELIGENSE� <br /> CONTRAGT PRICE OF WORK <br /> Od6`� <br /> DE;.'RIBE WORK RND SOUARE FOOTRGE nIVOLVEO CONUCT PERSON AND PNONE NO. <br /> . , . 33 � <br /> UQ i HEREBV CERTIFY THAT I HAVE READ AND EJ(AMINED THIS <br /> PROPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBEIOWORRTTRCMTWOfAPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHGRITY TO VIOLATE OR CANC6L 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 PROPERTV TO PERfORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> F�RCEL TAX ID.NUMBEB CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIOP�IORN LENDER.ADDRESS.TELEPHONE NUMBEN <br /> Y �.,-���3.�.� �-y �3 <br /> PROJECT ADDRESS ^ s�cn"`ei�7� w*e <br /> . / P CITVfi:FME55llG[NSENO <br /> � PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIM) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN _ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER 1_ <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 FA <br /> SINK(SERVICE—BAR,ETC.) I � <br /> I <br /> I <br /> 1 <br /> 1 � <br /> SUB TOTAL $ SUB TOTAI $ /D ' <br /> PERMIT $ PERM�T $ <br /> TOTAL FEE $ TOTAL FEE $ / ��` ' <br /> FOR OFFICE USF ONLY: <br /> FRONT SETBpCK fi[FF SGTBAGK SIDE SETBACK PLAN GHECH NUMOER FEE RECEIPT N0. <br /> /S�/(L <br /> USEZONE LOTRRER vncnNr5i7E FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING <br /> TYPE-O�-F�C^ONI57. NO.OFSTORIES oaUvuRv NOO�fyw/[LLn1,uH'*5 � <br /> ..WV Z B2 J PLUMBING � _ <br /> i <br /> SRE O�BLIX'i. FIRE SPRINyKlERS R[O'D BASEMENT MECHANICAL <br /> N') (J�(�'i l.`IdJ ❑ YES �N� �-- <br /> OC6UPANGY LOAD FlRE RLAFM qE0 D HEIGHT LIMITATION ADDITIONFL PLAN CHECK �_ <br /> ��w�� i <br /> wU GsrW�� OTHER � <br /> REn50N��11� "'��wh STATEBUILDINGSURCNARGE � <br /> N ✓� lwN I i <br /> MTANE BV PIANS�PPROVED BY CITY OF EVERETT PUBLIC WOFKS � <br /> <)M LOCAL SALES --'— <br /> onrE$� TAX CODE IS 3105 TOTAL <br />