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AP�L1�'ATIN"1 FOR CONSTRIICT:�11M PERMIT � <br /> TO BE COMPLETEL' IN BLACK INK—PLEASE PRINT <br /> �iEATiNG SYSTEhi: U GAS ❑ELECTHIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259-8810 ' <br /> ❑ DEMOUTION CI COMBINATION CI BUILDING 1=1 MECHANICAL LI PLUMBING SIGN <br /> OWNER M.4ILADDRE55 (.�fY ZIP PHONE <br /> �y.IJ.C.Gl/'L��IJ / S�l�� �l/.r,C_/-a.c-.t/ !i/�y C:4/C/Gc`�y _ <br /> TENANT MAILADORESS � � QTY ZIP PHONE <br /> ��'.���:»��j����.a � .���� - ���`��15� 22� ��'/���5�-C��/� . <br /> ARCHI?ECT Ofi UESIGNER lAAIL A0�'lES3 f.i7Y ZIP PMONE <br /> GENERAI CONTf1ACTOR MAI:P.DDP'c55 CITY 7.IP PHGNE STNE LICENSE■ <br /> ��z—i?,c'-7 �a.s�.t!=r/�33 . �?-r;-�.:-- iy,'!,� 1��� 333 .�'l3- � 9�J��;gs}a< �i/c��— <br /> MECHANICALCON'flACTOR MAILAUDRE55 CITV 21P � 4:A� STATEIICENSEp <br /> FWMBWGCONTflACTOa AIAILAODRE55 CITY 21P PHONE STATEIICENSLI <br /> GONTR�CT FRICE OF WONI� <br /> �t� f��. �-� <br /> G"— <br /> DESCRIBE WOFK ANO SOUAflE F"G7� E I OLVEO COHT�GT PERSON 4N0 PHONE NO. <br /> �i[f'�7lll�-- C�Ue:� -�� L://J,C.c.� ...��.G.� _'—�Gl��!/l'.�lS� 7//��/.�f�! — <br /> � t�� ��) "/� ��i,u��.v��-,�ls ��3- .��-- _ <br /> I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br /> raoaoseo useoFew�oiNc • APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> J��iO f� G��it%G=�/:�0.�� ������ � PFOVISIONS OF LAWS ANU ORDINANCES GOVERNING THIS TYPE OF <br /> LEOALDESCRIFfIONOFPR PERTY�SHOWNBELOWCRATi�CHTWOCOPIES� WOFK WILL BE COMPLETED WITH WHETHER SPECIFIE� HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES �IOT PRESUME T!� GIVE <br /> . �oT BLOJd or — AUTHORITY TO VIOLATE OR CANCEL THE PRUVISiONS 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 T41S PROPERTY TO PERFORM THE WORK FOH WHICH <br /> ' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAACELTA%I.D.NIIMBER CONTRA�OA LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDEF,AODRESS,TELEPH01lE NUTA�ER � /� � //�// <br /> Y �L/7� //�Lfc—_� /'' /'Y. <br /> PRO ECT ADDRESS ^'�"""'aE ' wtE <br /> L L C ��� . ,�c•-�ts� � .G/ CRYBUSINESSPCENSENO. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIHNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATE•RS-8:`t' M _T_ <br /> SHOWER ' CLOTHES DR��F � ' <br /> KITCHEN SIMK 8 DISP � ; VENTILATIOIJ F/�.iJ _ � <br /> � DISHWASHER � HANGE H000 � <br /> LAUNDRYTRAY ; WATEF HEATER ' <br /> CLOTHES WASHER � VJ(lOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIP�^'.ACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS°IPING � <br /> � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> i ' <br /> — i ' <br /> � <br /> � ' <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ <br /> TOTAL FEE S ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK FEARSETBACK SIOESETBACH PLnNCHEC NVMBER FEE RECEIPiNO. <br /> �-97 � 9s iio5 _ <br /> uSezoN=_ � " IOTAREA vncnNrsire FEES VALUATION FEE. <br /> �"L la Lp� ❑ YES - NO BUILDING Z � <br /> TYPEOFCONST. NO.OFSTORIES acUVAxtr t;00i0w[lllNGuula � <br /> tnouP PLUMBING i ' <br /> —�'— <br /> SIZEOFBLDC. FNESPRINKLERSREO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ No . — � <br /> OCCVPANCY LOAD FIRE ALARM RE�'D NEIGHT LIlAITATION AODITIONAL PLAN GHECK � <br /> i <br /> C7FU r OTHER i <br /> R'cA50N ��� <br /> 51'ATE BUILDING SURCHARGE <br /> — i <br /> INT4NE9Y PLANSAP ROVEUBV CITY OF EVERETT PUBLIC WORKS � <br /> � LOCALSALES � <br /> nnr,: � _ 5.'1� TAX CO�E IS 3105 roTa� � 7;J�; <br />