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APPLICATIQ"~ FOR CONSTRUCT�"�N PERM67 � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �1EATING SYSTEM: �GAS J ELECTRIC ❑ <br /> 259-8810 <br /> f : DEMOLITION i-� COMBINATION �BUILDING ❑MECHANICAL ❑PLUMSBING ❑ SIGN <br /> � �ER IAAILADOPE55 QtV ZIP PHONE <br /> R�c6�rc� Wosilowslv', «3z Celby , Eve�e�'f' 99201 �S� 25�7 <br /> TENANT MAIL ADDRE55 GITY Z1P PNOFlE <br /> AqCHITECTORDESiGNE9 MAILADpRE55 GIiV ZIP VMONE <br /> Milc� Nickersen, Z7Z2 Colby �Go7 �veraff' 98ZD/ 259-ISGO <br /> GENERAI CO�N�TpR,qC^TOR J� 1dn1L ADDFESS CITY ZiP FHONE STATE UCENSE/ <br /> �W/'��C� <br /> MECHANICALGONTPACTOR MAILADDRE55 CITV ZIP PHONE StATELICENSEY <br /> PLIIMBING GONTRACTOH MAIL ADUAE55 QTY 21P PHqNE ST/�TE UCENSE M <br /> CONTFAGT PRICE OF WOPK ���� % —� . <br /> DESC B��1RN NDSO�flE TAGEINV�VE= ��LO / CON!PCTPERSONANDPHON[ <br /> O J. T c%l/ <br /> Addifion } JZ,�mo.l�l � - (o!o <br /> f �j� I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF OUILDING S1 A IC� F4T I I �c.Gd t�AC APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINAIJCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTIONOFPROPEFTVISNOWNBELOWOFATTACN4WOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> / �/�� �L�-r p F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oY� a�aK 1-�Ts— oF �� �� AUTHOFITY TO \'IOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��J��yQ TT a/U/�lD/� L OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> --- PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTHOR�ZE�BY THE <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br /> APPL�CATION IS MADE AND 1 CO�v1PLV WITH THE STATE <br /> Paaee�ux i o NUMeen CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �3�pD.3 /6/ 7000 <br /> CONSTRULTIONLOANLfNDtA.ADDRESS,TELEPHONENUMOER �________�� <br /> �—Z S�S� <br /> PROJECT ADDRESS //� {/� /wy�/� i. �rur+e o�tr, <br /> 1G32Y�1�/ / ,Y�• �I p1LBlI5MF55lIC[NSENO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A'C—A/HNDLG UNITS—H.P. <br /> � BATHTUB 1 _ FORGED AIR SVSTEMS—B.iU. M E.A. ' <br /> LAVATC�FY IWASH BASIN) � i 11N1T HEATERS—B.T.U. M i <br /> SHOKcF ' CLOTHESDRYERS — <br /> r KITCHEN SINK 8 DISP � VENTILATION FAN i <br /> ( DISHWASHER � � RANGE HOOD '' � <br /> LAUNDRY TRAV WATEH HEATEF ' <br /> GLOTHES WASH[R -� � WOOD STUVE <br /> URINAL METAL FIREPLACE jWOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT i <br /> —T- <br /> FLOOR DRAIPJ � HEAT PUMP � <br /> BACKFLOW PFEVENTERS GAS PIPING <br /> ROOFDRAINS—RAINLEADERS EXHAUSTFAN /� � <br /> SINK(SERVICE—BAR.ETC.� � � <br /> � � <br /> --�' <br /> _ ; <br /> I <br /> SUB TOTAL 5 SUB TnTA! 5 � <br /> PERMIT $ PERMIT S <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> h"OR OFFICE USE ONLY: <br /> FRONTSETB/GK _ FEAqSETBACK � SIOESETB� � / PLAN EfXNUM6 P FEE /' RECEIPTNO. <br /> �J IJ � C /I� Q <br /> 6�`' C <br /> usezoNe 7 � �ornaen VACANTSIT �� FEES VALUATION FEE <br /> �Z!/ '�.7 YES " rv� BUILDING 3q '3 1�7 '2O <br /> T1PEOfG0II5i. NOAFSTORIES U.[urRlqv !ioRRAfic'a!:tns <br /> unnuo PLUMBING i <br /> �-N 2 -3 1 <br /> SIZEOFBIDG. FIRESPPMKLEPSFEOD BASEMENT MECHANICAL ��O � <br /> SZ�'}� S , � YFS . NO � <br /> OGCUPANCVLOAO FIREAIARMRE00 MEiGHTIIIAITATION J ADDITIONALPLANCHECK i <br /> �� j <br /> OiHER ' <br /> PEASON � .� <br /> SiATE BUILDING SURCHARGE <br /> � <br />, ItlTA✓E BY PLANSAPP OVED BY CITY OF EVERETT PUBLIC WORKS � <br /> �1-� LOCAL SALES <br /> oA,E �Z�9 5 TAX CO�E IS 31�5 TOTAL /�� ,�; l�� <br />