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APPLICATIC`i FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _. —� <br /> 259-8810 <br /> i I DEMOLITION I I COMBINATION 1Q BUILOING ' I MECHANICAL I I PLUMBING I I SION <br /> OWNER M�IL�O�HE55 LITY IIP PHONE <br /> 'TblG $EEIN6 Co. � M�S oy—IZ .. P0. Qdx 3��')�S�"A�ITLC, �✓9. 90/L� ?•��-3•�f1 <br /> TEN�Ni M�IL A�URE55—� d7Y ZIP PNONE <br /> 2esl�+�• <br /> �RCNITECTOfIDE5N3NER MML�OORESS Giv ZIP PNONE <br /> �OCiN�. <br /> GENER�L CONTqACTOR M�II AUDRESS GiV IIP PIqNE STATE I.ICcNSE� <br /> ?7lc' Qasr+6A. �o - <br /> MECN�HIC�LCOlITRACTOH MMLAODRESS CITV 21P PHONE STATELICENSE� <br /> PWMBINfiCONTRACTOR MAIL�ODRESS CIiV ZIP PHONE STAELICENSE� <br /> C(MlTR�LT PRIGE OF WONK <br /> 3 �t0e <br /> DESCNIBE WORK AND SOUANE FOOiAGE INVOIVED CONTACT PENSON AND PMONE NO. I <br /> /ivss'�rw Dcin�U�'�iiLd' l�.a.Ti...�s L�N�'^� /'�5T'��"�Lic�tsr.� Zi�-3�'lJ <br /> I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> . PROPOSED USE OF BUIlUINO APPLICA710N AN�KNOW THE SAME TO BE TRUF AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVL.�NING THIS TYPE OF <br /> LEO/�lDESCRIPTIONOFPNOPENTV�SHOWNBELOWORAT7ACHIN'OCOPIE51 WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE ORANTINO OF A PERMIT OOES NOT PRESUME TO GIVE <br /> tor e�ocK o� AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � OTHER STATE OR LOCAL LAW REGUUTING CONSTqUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BV THE <br /> � OYlNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �, APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> VARCEL TA%I D NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ' CONSTRUCTpNLMNIENDER.ADDRES5.7ELEP110NENUMBEP P ,�. / /� 3/1Y�SI <br /> r.7.��__/ (r/T/ <br /> _ ���AO�E{j��� //� 6pNAilrlE 04E <br /> � �� �I• �/Tl��O /y. ���• Z CrtY&1SMESSL�LfN5E1q <br /> � p��p MECNAINCAL <br /> � N0. T1'/E OF FlIRWIE OII ITEM FEE N0. TYPE OF EWIPMENT FEE <br /> � WATER CLOSET(TOILET) � AI�AIFINDLG UNITS—H.P. � <br /> , BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> �. LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> �� SHOWER CLOTHESOHYERS ' _ <br /> KI?CHEN SINK 8 DISP � VENTILATION FAN ; <br /> UISHWASHER � RANOE HOOD <br /> LAUNDRY TRAV ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIFEPLACE(WOOD BUHNING) ' <br /> DRINKING FOUNTAIN � FlHEPLACE INSEHT � � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIPINO � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL E � SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> Fon o�ce use oN�r: <br /> FRONTSE7B�LK REMSETBAGK SIDESET&1CR PLANGHE KNU A fEE RECEIPTNO. <br /> � ��ji0 <br /> useione �ornr�e� VALMlTSITE FEEB VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> TYVf Of ClWSi NO.OF STOFIES ocwr•xn' ra a uxuiixcuxns � <br /> 01�j PLUMBIN4 � <br /> � '� _ 'L � <br /> SIIE OFtlBLPO. FIR��P�KLEflS PEO'D B�SEMENT MECHANICAL � <br /> �SQ �' YES i.l NO � <br /> pg���y�p�p FIRE AURM RE00 MEIuHT�IMIT�TION ADDITIONAL PLAN CHECK i _ <br /> � <br /> EI OTHER ' <br /> REASON <br /> Cr/��r�] STA7E BUILDING SUHCHAHGE <br /> i <br /> iNTA1tEBY P PPROVEDB� CITY OF EVERETT PUBLIC WORNS i <br /> LOCAL SALES � <br /> o„ 1,�, 5� TAIf CODE 18 3105 TOTAL � <br />