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APPLICATIC"i FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: J GAS J ELECTRIC !J_ <br /> 259-881 D <br /> OEMOLITION ' COMBINATION X BUIL�ING MECHANICAL PLUMBING ' SIGN <br /> OWNER MR�I��ORE55 ❑1 ZiP PNONE <br /> lflu BnE�,�s C�. � l�.n. �yrx3�7o'I , M�S vF-7G SE'.�-7'l�'��.✓/.+ .yP�zs% zcc - ,3�'�s <br /> TENANT M�ILADOFE55 LITY 21P PNONE <br /> j0-M S /FS f>w iv6 A� <br /> ARCHILELTOROESIGNER MRII�DDRESS CIiY ZIP PNONE <br /> 7'�fE g�'EiNC c.;. <br /> GENER4L�TRACTOR M�IL p[1DRE55 GITv 21P PHONE SiAiE UCENSE� <br /> 1— � <br /> MECH�NICAICONTR�CiOP M�IL�OORE55 CITY 21P PNONE SiATEIICENSE� <br /> PLUMflINGGONTPAG70R MML���RESS CITY IIP PHONE ST�TELILENSE� <br /> CONiRACT 1'RICE OFy")ORK <br /> U � <br /> DESCRIgE WORR AND 50 ARE FOO7�GE INVOLVED CONiRCT PERSON ANO PMOHE NO <br /> Mf�027h <br /> Co,vSf/�vr.T G.,vr t. Ls n�cL.�S••�aF" [,6oNPn r� �57"�I"1/f0,�>t� 2LE -3J�j <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �,rm pp�tA2y (,vpR,k /9'2E9• PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIGTIONOFPROPERTVISNOWNBELOWOPATT�CMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BIOLN or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEp BV THE <br /> OWNEH OF THIS PpOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPGEL TA%I D Nl1MBEN CONTRACTOHS LAW 18.27 RCW AND 296.200 WAC. <br /> LONSTf1UCT10N LOAN IENDER.ADDRE55.TELEPHONE NUMBER <br /> �1 �• ' �- Ie�3I93 <br /> PROJECT ADDRESS sLi`w�rune o��e <br /> DO C/F5�ND /L�, �ilYBUSMfSSUCEN5EN0 <br /> PLUMlINO MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� NC—NHNDLG UNITS—H.R � <br /> BATHTUB ; FORCEDAIRSVSTEMS—B.T.U. M E.A. � <br /> LAVATOHV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDPVEHS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> � DISHWASHER � RANGEHOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT I <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ' <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S <br /> PEfiMIT S PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FpONTSETBACR REARSETBACN SIDESEiBACN PLANCNlCNNUMBE FEE AELEIPTNO <br /> < );< < <br /> use ior+e LOT ARE� WC�NT SRE FEE VALUATION FEE <br /> G YES � �. NO BUIL�ING S O00 7Z 'L'� <br /> TYPEOfC�N51 NOOFSiORIES aav�rycr NawoWFwNGUNits � <br /> � _� � �t��� PLUMBINO ' <br /> 52EOFBlDG iIRESPRINNLEN5RE00 B�SEMEN7 MECHANICAL <br /> bJ) � ,F"( � ' ' YES �i. NO � <br /> CUP�NCY LOAO Fl E AlAR1A RE00 NE1GHi IIMITATION A�OITIONAL PLAN CHECK � <br /> O�U OTHER � <br /> i <br /> fiEA50N <br /> � ���'J0.�R✓ �����/ C� ��jC S7ATEBWLOINGSURGHARGE L i <br /> INT�KE BY VLANS PPOVE�Bv CITY OF EVERETT PUBLIC WORKS � <br /> �In, LOCAL SALES , <br /> o�re �p . �u _S J TAX CODE IS 3105 Tor�� � <br />