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i ' APPLICATIaI FOR CONSTRUCT'`'�N PERMIT <br /> � TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rrr <br /> I <br /> � BUILDING DEPARTMENT <br /> r HEATING SYSTEM: ❑GAS ❑ELECTRIC iy� np��, <br /> 259 8810 � <br /> i_ DEMOLITION YCOMBINATION i! BUILDING f�MECHANICAL " PLUMBING I SIGN <br /> OWNER MqIL ApDRE55 CITY 21P PHONE <br /> Wl��inn+ c.1,�1tCA�v� 113� G�tey �-rl6Pt/T ABAo/ as5-s484 <br /> TENANT M�ILRDDRESS GRY ZIP PHpNE <br /> i <br /> ARCHITECiIXiDES�GNER M�Il4DDRE55 C�TY DP PHONE <br /> 1 �- <br /> I l+'��tJ�ion d4iE CAtiF rd£�r�71 4f'do� asa Qaoo <br /> GENENQ LONTRApTOP MAII ADD9ES5 pltV ZIP PHONE STpTE LICENSE/ <br /> � SP IE' <br /> MCCM�NIGI�LCANTRACTOR MAILqDDRE55 CITV Z�P CMpNE STRTELICENSE• <br /> _ 5�e IP <br /> PWMBINGGONTRACTOR MP,ILAODRESS CITV ZIP PNONE STAiELICENSE/ <br /> LONTqACT PRICE OF WORK <br /> � I 7 <br /> � �ESCR9E WOAN�N�SOU RE F00�� INVOLVEO �pNTq�T PEfi50N AND PHONE NO <br /> �aQaF� C � � � - a a SQ �, cA,r�� oe a,�� w��� <br /> a�-�8ti <br /> ' i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSED USE OF BUILDMG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � CA� r Ro�rr STOIP L= PROVISIONS OF LAWS AND OiiDINANCES GOVERNING THIS TVPE OF <br /> ILEG�lDESCRIPT10NpFPROPEPTV�SHpWNBELOWORATfACHTWOCOPIES� WORK WILL 9E COMPLETED WITH WHETHER SF=CIFIED HEREIN OR <br /> I �or 9�32- e�ocK �L oc NE14HTS /�A� NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> AUTHOflITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> 1"p �f/CQC-TJ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> � - � OWNER OF THIS PROPER7V TO PERFORM THE WOFK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> PAPCEL T�X ID.NUMBER CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> �/6Bti-�a - a1u _ o00 <br /> I CONSTRUGTIONIO�NLENDER.ADDRE55.TELEPMONENUMBER �/` n/ <br /> ND�*IC- lL%�'���,�N�� ���a2�4Y <br /> PROJECT ADDRESS s�c�u�uae o�rE <br /> 13D (.p CJ � crcvousro+cssiiceus[Ho - <br /> ���� MECHANICAL <br /> INO. TYPE OF FlIITURE Op ITEM FEE NO. TYPE Of EOUIPMENT FEE <br /> WATER CLbSET(TOILETI A/C—A/HNDLG UNITS—H.P. <br /> I BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. <br /> I LAVATORY(WASH BASIN) , UNIT HEATERS--B.T.U. M _ <br /> SHOWER � CLOTHES DRYERS <br /> I KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> / UUNDRV'TRAV ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING� � <br /> DRINKING FOUNTAIN � FIREPLACE INSEFT ' <br /> — , <br /> � FLOOR DRAIN HEAT PUMP <br /> ;� `� BACKFLOW PREVEKTERS GAS PIPING � <br /> n� � '� . ROOF DRAINS—RAINLEADERS EXHAUST FAN �— <br /> � �` SINK(SERVICE—BAR,ETC.) � � <br /> _ � <br /> — <br /> � <br /> �— <br /> SUB TOTAI $ SUB TOTAL $ <br /> PERMIT $ i PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ � <br /> ' FOA OFFlCE USE ONLY: <br /> FNOHT SETB�CN REAR SETBRCK SIpE SETB PLe.N CHECK UMB R FEE RFCEIPi NO <br /> � � /J� � � ,� /CU� `- <br /> usezone LOTAPEA vn Ntsire FEES VALUATION FEE <br /> � '� �� �� ��! VES �� NO BUILOING /X��J � <br /> TVPFO�CONST N OFSTOFIES ntcuai,NCv xoo�pvrtuixGuxrtS S —+-��— <br /> , ; �aa'_� � PLUIdBING � <br /> i <br /> SIZEOfBLOG. FIFESPRINRIEFSPEO'0 BFSEMENT T— <br /> � `J Li YES �NO MECMANICAL � <br /> Z F. — , <br /> OCCUPANCY SOAD FIRE AIARM REO'0 HEIGHT LIMITpT�pN ADOILIOIJAL PLAN CHECK ' <br /> A },1�D z/ ' � <br /> OiHER � <br /> i � fiEA50N ' <br /> STATE BUILOWG SURCHARGE � <br /> � , MT�KE BV PLAN�PP oeoeY - CITY OF EVERETT PUBLIC WORNS _� <br /> LOCAL SALES <br /> ( oeTe TAX CODE IS 3105 TOTAL ' � v <br />� <br />