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APPLICATIC�1 FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SVSTEM: � GAS J ELECTRIC �.J_ � <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING i MECHANICAL i PLUMBING I SIGN <br /> OWNEP MNLAODRESS CITY ZIP PHONE <br /> .�Iv �10�,.�.�ct � ('����..� Pn R ;3 0 � ��.�e.re# l A�a q gd o 3 �y� � 1�y <br /> LENANT MRI DORESS I CRY ZIP ) PHONE <br /> ARCMiTECiOPDE5IGNER MBiLADDNESS CITV ZN PHONE <br /> ENERALCONTPPCTOR MAILA ORE55 CITV ZiP PHONE STATEIICENSEN <br /> - 2�-�4J�`- 151 KI — <br /> MEC/N�IWICALCpn�yTqACTOR MAILADDRESS CITY 21P PHONE STRTEUCENSEY <br /> / I�Ln/��A <br /> PLU iNGCONTMC-0 MPILAUDRESS GITY ➢P PHONE STATELICENSEY <br /> CONT CT PRICE OF WOHK <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON ANO PHONE NO. <br /> l <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> VPOPOSED USE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWo AND OfiDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESrCRIPTI N FPROPERTY�SHOWNBELOWOCNADTTACHTWOCO(P�I�,s1� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �orJ-- e�ocK as � � / J NOT. THE GRANTING OF A PERMfT DOES NOT PRESUME TO GIVE <br /> AUTHO>i1TV TO VIOLA?E OR CANCEL THE PROVISIONS OF ANV <br /> OTHEH STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCt OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHIC11 <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PqRCELTA%I.D NIIMBER CONTRACTORS�.^:': �tl27 RCW AND296200 WAC. <br /> �ONSTRUCTION OAN LENDER.A ORESS.TELEPHONE NUMBER <br /> o X i,���., ;'1 n�.4,��a.0 y - y -44 <br /> aecr�ooness s��-��� � �" <br /> crtv eusH ucense r�o. - �� <br /> p�pyg�� MECMANICAL <br /> Np. TYPE OF FIXTURE OH REM FEE N0. TYPE OF EOUIPMENf FEE <br /> WATER CLOSET(TOILE� A/C—AIHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> ( KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> -�— <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRVTRAV i WATER HEATER <br /> � CLOTHES WASHER WOOD STOVE <br /> URINAL METAL F�REPIACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � / <br /> SINK(SERVICE—BAR,ETC.) <br /> �� <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFRCE USE ONLY: C �5 <br /> FflONTSETB�CK PERRSEtBRCN SIDESETBRCk PLRNCNECKN��R�I FE�J� AE�9��� <br /> 7 0 ' 2a � /o ' S' :.; <br /> use za+e �ot a A VACANT 51 FEES VALUATION FEE <br /> � �,�5 I: VES � NO BUILDING �p� g3 ' �' <br /> tYVEOiCONST NO.OFSTORIES Octuvqrvcr xoo�mv[wxcuNrts / �J <br /> �� ° PLUMBING (j',,,J� <br /> SRE OF BID�GF FIRE SPRINNLEHS REO'D BRSEMENi � � MECHANICAL (y(J � <br /> � TF�C#R O -�. VES ��!NO 1— <br /> OGCUiANCV LOr1D FIRE ALARM REO'D HEIGMT UMITqTION / <br /> ADDITIONAI PLAN CHECK '�'�� <br /> � V OTHER ! �� <br /> ---r— <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> INT�KE BV PIANS APP ED BV CITY OF EVERETT PUBLIC WORKS `O � <br /> LOCALSALES <br /> pl1TE � TAX CODE IS 3105 TOTAL / �� <br />