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APPLICATIC 1 FOR CONSTRUCT )N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIiJT � <br /> BUILDING DEPARTMENT CEATING SYSTEM: U GAS U ELECTRIC tU_ � <br /> 259-8810 —' <br /> f ] DEMOLITION '1 COMBINATION I l BUILDING I i MECHANICAL ➢QpLU!MBING I 1 SIGN <br /> OWNER II�LL�DDRE55 GTY <br /> ZIP pHpryE <br /> /r�S %N s Gao..�� — <br /> TEN�NT MAIL�ODRE55 CITY <br /> . � J�_ ZIP PNOHE — <br /> ! <br /> ARCHITEC7IXi DESqHER M��.L IIDDRESS CITV <br /> 21P PNONE ' <br /> OENERAL CUITR�CTOR MMl�OURESS GTV Z�p — _ <br /> P�E SGTE IIGENSE� <br /> MECN�NIG1lCONTq�CTOR M�IL�DORF.dS GITY IIP <br /> P�E ST�TEl10EN5E� <br /> PLUMBINOC�NTRACTOq M�IL�OUlIESS ��n• z�P <br /> / ��E SUTE UCENSE� <br /> DeJ ���Ilr P/�,n`sc � 67�7 drr-�/.r� �=„r w.�, •.t'o Fcr'o9 <br /> GONTRACT PRICE OF WORK <br /> DESCRIBE YNRK�ND Sq1ARE F007�OE INVOIVED CONT�CT PERSON AN�PHONE NO — <br /> vnoroseouseoFeunoiNa � HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TAUE AND COHRECT.ALL <br /> PR(1VISIONS OF LAWS AN�ORDINANCES OOVERNINO THIS TYPE OF <br /> LEWLDESCRIPTqNOFPqOPERTY�yMpWqBELOWORAi7ACHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot B�ppK aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE O{i LOCAL LAW REGULATING CONSTRUCTION Oq THE <br /> PERFORMANCE OF CON3TRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%ID NUMBEq APPLICATION I:i MADE AND 1 COMPLV WITH THE STATG <br /> CONTRACTORS L�W 18.27 pCW AND 296200 WAC. <br /> Cp15TRUCTION LO�N LENDEfl,A�ORE65.TELEPHpNE NUMBER <br /> PROJECTADDREBS saN�runc� �� ����7 p� <br /> ��� 1'' J � O�IE <br /> ~ �l~� �" C�ir Ci1YflUSMfB9lN:fNSEHp ��- <br /> P��� MECMANICAL <br /> MO• TYPE OF fll(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT �E <br /> _� WATERCLOSET�TOILET) � NC—A,'HNDLGUNITS—H.P. �- <br /> BATHTUB ' FORCEDAIRSI'STEMS—B.T.U. M E.A. —'— <br /> LAVATORY(WASH BAL�N) � UNIT HEATEHS—B.T.U. M � - <br /> SHOWER CLOTHESDFYERS - <br /> KITCHEN SINK 6 DISP ' VENTILATION FAN �- <br /> DISHWASHER � RANGE HOOD � ' <br /> LAUNDRYTqAV ; / WqTER HEATER - <br /> CLOTHES WASHER � WOOp STOVE i—' <br /> URINAL � METAL FIREPLACE�WOOD BURNINO) � <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT � - <br /> FLOOR DRAIN � HEAT PUMP —T--- <br /> _ BACKFLOW PREVENTERS ; GAS PIPING � - <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � - <br /> SINK(SERVICE—BAq,ETQ) � - <br /> � ; - <br /> , ' _.. <br /> � , ' <br /> � - <br /> SUB TOTAL S ; SUB TOTAL S ' � <br /> PERMIT S � i PERMIT S ' <br /> TGTAL FEE S ' � TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT6ETB�CK RE�RSET&1CN SIDE6ETBACK P�ANCHE RNI/MBEF FEE RECEiPiNO. <br /> �S/ <br /> use zar�e �OT�RE� V�GNT SITE FEES VALUATION FEE <br /> Cl YES ❑ NO BUILD�NG � <br /> 1YPFOfCONSt. �OFSiORIE3 atuMxr lqaowtLLnGUNn! ' <br /> ��� PLUMBING � � <br /> fiIZE OF BLDO. FIRE BPRINNLERS REO'D BASEMENT MECHANICAL � <br /> i� ves r; No � � <br /> OCCUPANCYlWO FIREALARMREO'D MEIONTIIMIT�➢ON ADDITIONALPUNCHECK 1 i <br /> i <br /> qE�� OTHER ' <br /> i <br /> —�_ <br /> STATE BUILDING SUFCHAROE <br /> INT�kE BY PL�NS APPROVEU BY CITY OF EVERETT PUBLIC WORNS � <br /> LOCALSALES <br /> o�.e TAK COOE IS 3105 TOTAL <br /> } <br />