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APPLICQiTIQ : FOR CONSTRUCT'"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: 'J GAS �ELECTRIC J _ <br /> 6UILDING DEPART�J�ENT <br /> 259-8810 <br /> l DEMOLITION l 1 COMBINATION * BUILDING If MECHANICAL i+PLUMBING L' SIGN <br /> CWNER MAIL�DDP,[SS CrtV ZIP PMONE <br /> JDH §Ra�P 2�3/ WEsrMoRE Av� �5ae Ev�'��r w�• 9820� 2� 3B8•84o0 _ <br /> TENANT MAiLADDALSS CITV ZIP P�iONE <br /> MERRiLL �Y�1 � �. /n� 8��c�'�S ,PMv Pl,AirvSBa� N.✓, oEti�G�(�1� 28'2•4Z/5 <br /> ARCNRECTOF�ESIGNER MAIIADDRESS QTY ZIP PHONE a/L1. It.'� <br /> R �J <br /> p��iin R �YIa�uPNiN4 35o GAL/Ifa4N4d ST I/� SA_�tA�G�4�•44�/ot 3�ras� 3d�$•o0 5749 <br /> GEN.Q(�'LC NTRAGTON ��LAODRE 5 CITV ZiP P��ONE S7AfElICENSE� ♦ <br /> �j(�0 /� .�� /���_/ �� / _ <br /> MECMI.N�:ALCGNTPALTOR MNlA�DRE55 GITV 21P �NO�JE STAiELILEN5E� <br /> PLUTABINO CdJTRALTOR MAIL ADt1RES5 CITV IIP PHON6 STATE UC[NSE I <br /> CONiRAC1 PFICE OF WORN <br /> �C � aM MA N1 �CS7JMA7?S� <br /> DESGFiBE O N AND SOUFRE F007FGE�NVOLVED GONTACT PEPSON FND PHONE NO� �� <br /> G i_ ro�.���1vx���4� (q/s ��, Fivx �l <br /> i HEREBV CERTIFV TF1AT I HAVE READ AND EXAMINED THIS <br /> PROPOSfD USE GF DUILDING APPLICATION AND KNGW THE SAME TO BE 1RUE AND CORRECi.ALL <br /> B�L O /Gfi PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br /> LECAlDESGRIPTIONOFPROPERTY�SHOWNBFIOWONATTAGNTWOCOPIES� NOT THELGRA T NG OF AD ERMITJDOES NOT f`a�ESUME TO G�E <br /> G <br /> �pr � � — e�oCK �?'—/'S— �F V��rr AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � � <br /> -- PERFORMANCE OF CONSTRUCTION.TNAT I AM AUTNOPI2ED BY THE <br /> OWtJER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PANG[LTA%I.�NIIMBER CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIONIORNIENDER.A00RE5S.TELEPMONENUMBER ^_. ' � — <br /> N�/4 I] X — oe�[ � <br /> PROJECTADDHESS CI�i�TT /,I �WC� 61.�����p� <br /> � � cnvoovrassua�+sn� <br /> PLUMBING /V • ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEfI CLOSET(TOILET) A'C—A�HNDLG UtJITS—H.P. � <br /> FGRCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB � <br /> LAVATOfiY(WASH BASIN) UNIf HEATERS-3.T.U. M � <br /> SHOWER ' CLO"HESDRYERS <br /> ' VENT�IATION FAN <br /> KITGH[N SINK 8 DISP _ <br /> DISITYlASHER RANGE HOOD ' <br /> ' \NATER i1EATER � <br /> LAUNDRYTRAY __T <br /> CLOTHES WASHER WOOD S'OVE <br /> .URINAL _ METAL FIFC-PLAI;E IWOOD BURNING) �— <br /> � DRINKING FOUNTAIN � FIPEPLACE INSERT � <br /> HEAT PUMP <br /> � FLOOR DRAIN � - � <br /> BACKFLOW PRE:�ENTERS ; uAS PIPING _—� <br /> ROOF DRAINS—flAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAFi.ETQ) �_ -- <br /> i <br /> — � I <br /> ' — � <br /> SUBTOTHL 8 SU�TOTAL 5 <br /> — PGRMIT £ PERMIT 5 _ <br /> — TOTALFEE S TOTALFEE Y <br /> FOR OFFICE USE QNLY: � L. ��!'�J , � :c Lu- 1%CC �'U�'L — u'n w�" <br /> — PLANCNEGKNUM�EP FEF <br /> R[CEIP 0 � /.0�� <br /> FROHTSEiBACK FE�P.SET04GK SID cR1PCH ��_�� � �.�G7 nh�`� ��� <br /> �`�� � � (/�i <br /> �oraRen vncnNtsrtE FEES VALUATION FEE <br /> USE ZDNE � 'L� � <br /> ❑ YES �' � NO pUILDING I� "F � <br /> iYPEOFLONST ��0-OFSTCRIES u,-cuPu2r xoawRwxf,u•�n5 � <br /> -}� �"00� pLUMBING ' <br /> �1 ��z i ri. r�..�. a' — , <br /> SIZE OF BL�G. <br /> FIPESPfiiNNlERSR[UD BASEIAFNT MECHANICAL � <br /> 4,�C . . Y�> SLYES ❑ NO �-- ; <br /> AD��TIONAL PLAN CHECr: � <br /> OCCUP/P�,N-yCVIOA� FIR[A1�FlIPE00 NEIGHiL!I�ITATI�N � <br /> ✓/ ���1 ._ OTHEF � <br /> AEA'�N JJ/� pl �y�� ,1/ //�r� STATE BWLDING SU�CHARGE � D <br /> I K:7'� I�f'ifi L'f�'l/l.�IrY � <br /> �HTnk[Nv PLn's�PPROVED Bv CITY OF EVERETT PU�LIC WORNS � <br /> (�M LQCAL SALES <br /> on��= oe/ <' <br /> TAx C00E IS 3105 TOTAL '�J` ) <br />