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APPLICATIQ^ FOR CONSTRUCTI'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: f$GAS U ELECTRIC J —� <br /> 259-8810 <br /> i l DEMOLITION pQ COMBINATION I I BUILDING I I MECHANICAL f I PLUMBING I I SION <br /> OWNER IA�IL�OORE55 CITY IIP VMONE <br /> Ct1L�r��3 ia. i2 �.+rn c..e..�� /h'/S�/90i-' �nax� ie..w `! S 2 ? .S- rI�'3 -c�c�c>n <br /> 7ENANT M�IL�fl�PESS CIiY 21P PHONE <br /> '� � /� O�'1 <br /> ARCHIiEG1LR0ES10NER M�ILAODHE55 CITV 21P PNONE <br /> lLO cL;�son /5601 2� r�.� .a .r' N ci .5 �'_ctT F.. �_!.� / 77 '/� <br /> OENERAL TR�CTOR M�IL�DORE55 CITV ZIP PMONE IYJ / /��iT <br /> L[L�a.•�.!?(ar /ZIw� CJ��� /A/'j- /S � - vnsti/C/L%C� •Vct /�'q � 75 �J7�C�cJdn <br /> MECHANIC0.CONTR�LTOR MRIL ADORE55 CITY 21P PNONE Si�TE UCENSE/ <br /> PLUMBIN7 CONTRACTOR M�IL AODRESS dTY ZIP PNONF. STA1E LICENSE I <br /> CON CT PPIC OF Wf%IN <br /> 2sa 7�'3�d <br /> DESCRIBEWOPK�NDSW�REFOOTROEINVOLVEO �ONTRf. PERSONANDPII�NENO. <br /> /'1 �.�[J /��) �"r� t q— 400 <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF BUILOINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> C �'V � 'oz. -` PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTqNOFPPOf+ERTV�SNOWNBELOWOR�TTACNTWOCOPIES� WORK WILL BE COMPLETED WIiH WHETHEfl SPECIFIED HEREIN OR <br /> �ot e�ocK ov _ NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> — AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> /OC Z i4..rL� L !t r� �t I )T � OTHER STATE OR LOCAL LAW REGULATINQ CONSTRUCTION OR THE <br /> �' PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> R,CA a�v���s or OWNER OF THIS PROPERTV TO PERFOHM THE WORK FOH WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAM 10.NUMBEN CONTRACTORS LAW 18.27 RCW AND 298200 WAC. <br /> CONSTRUCTIONIO�NlENOER,ADORE55.TELEPHONENUMBER <br /> �f�� � /-�v -i� <br /> PROJECT DORE�B ��I�uxy�/�%'?�'�'� o�i¢ <br /> LITY BUS�NE49 L¢ENSE Iq <br /> PLUMlINO MECMANICAL <br /> NO. TYVE OF fl IIE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) ��� NC—NHNDL6 UNI7S—H.P. � <br /> BATHTUB / ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) I/// � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � ; VENTILATI^,N FAN ; <br /> / DISHWASHER � RANGE HOOD —�— <br /> LAUNDFY TRAY ; WATER HEA7ER <br /> CIOTHES WASHER � WOOD STOVE ; <br /> URINAL ' METALFIREPLACE�WOOU BURNING) <br /> ORINHING FOUNTAIN F�HEPLACE INSEFT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SEHVICE—BAR,ETC.) ; � <br /> — ; <br /> � ; <br /> SUB TOTAL S ; - SUB TOTAL $ <br /> PEFMIT $ � PERMIT S ' <br /> 70TALFEE $ TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT�T1BA�� RES��C'N � SIDESEiB�CK PLCC�HE%K�MBER FEE r� � RECEIPT��� <br /> r RL / J �, <br /> use z LOi�REA VACANT SITE FEES VALUATION FEE <br /> � �, a'�00 � YES [7 NO BUILDING � , `' <br /> rvvcorcoxst NOOFS�ORIES aav.nc xoaoxKumcuxrts � <br /> �„ 3 °R� ' PLUMBING <br /> SIIF p�BLDO + FIRE SPPINNLERS PFQ'D BASGMENT � <br /> I56 SF MECHANICAL CJ i <br /> A� f� YES 3Q NO � <br /> OCWPANCYLWD FIRE�URMPEO�U MEIGHTLIMITATION ADDI710NALPLANCMECK �77 <br /> � O1HER D � <br /> REASON � <br /> STATE BUILDING SURCHARGE ( ' <br /> INTANE BV P�ANS�PPPOVEOBY CITY OF EVERETT PUBLIC WORKS L1� � <br /> LOCAL SALES <br /> onre �S TAl(CODE IS 3105 TOiAL �2 <br />