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A�'PLICATI�*N FOR �OII�STRUCT'fDIV �ERMIT � <br /> TO BE CUMPLETED IN BLACK INK—PLEASE PRINi <br /> _ . __-- - -- -- ------� <br /> HEATING SYSTEM: !J GAS U E�ECTRIC J _____—___ <br /> BUILDING DEP.4RTMENT � — <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION i:1 BUILDING I MECHANICAL I PLUMBING �yy3iG`N <br /> OWNEP MRILA�DRE55 GITV Zu' I-�Ir1t![.. <br /> �c�ei,r� tY.�����- �9�7 c'.ec� ,ce�=-- ------ <br /> TEN' 1T RI AOORESS Cliv 21P PNGIIE <br /> �r' 1 , - ��L���rli .4��Sr'�i� <br /> . , , <br /> 'AqCMiTECT DESIGNEI MRILAODRE55 GIiY ZIP i'IIf.YL <br /> GENERAICONTR�CTOR MAILA�ORE55 CITY _-- TP ----�'PnOt:i—'—� S7ATGLIC[NSEI <br /> 7��i''x�-,�> �o r'r��.'3�-s` ��- ura-: 9�.�•!/�33 a��i��- �.-�ns�a-�3i�c� <br /> MECNRIICALCONTRACTOR MRIL ADDRE55 CITY 2� PHONI S1NE LIC[NSf./ <br /> PLUMdINGLONTRACTOR MAILADDRESS CITV 21P PNONE STAiELICENSEM <br /> GONTRACT Pf�E OF W AK ` \ <br /> fif �9� � - -.. <br /> OFSGPIBE WORK AND S WRE fODTAGE M W CO�YiACT PERSON PN�PHONL HJ <br /> /.tX1i�.c.�.— -7l,i� _7 � /t�/1,cc� _ .T:9�s��lIL171`-rS� <br /> %�l� �,c� �y�q'i� !�f/,o.�� �?3_�.J.�� <br /> � i HERE�Y CERTIFY THAT I HAVE READ AIJD EXAMINED THIS <br /> PROPOSED JSE OF BUILDING APPLICATION ANO KNOVJ TNE SAME TO BE TRU�AND CORRECT.ALL <br /> G-�,�,�:,.y7 �s�/y(//Jc�- 7dt✓'�'� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESLRIPi:ONiFPROPERTV�SMOWNOELOWORATfAGHTYOCOPIES) WORK WILL BE COIdPLETED 1'lITH WHETHER SPcCIFIED HEFcIN OR <br /> � NOT. THE GRANTING OF A PEFlMIT DOES h10T PhF.SUME TO GIVE <br /> � LOT.--- CLtlCK oF -' AUTHORITY 70 VIOL�ITE OR C�IJCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW RC-GULATWG CONSTRIJ'.TION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> OINNeR OF THIS PROPERTY TO PERPORM THE WORK FOR WHICH <br /> APPLICATION IS MAU[ ANU I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUIdBER CONTRAGTORSCR is.z�acva nNo zss.2eo wnc. <br /> CONSTPUCTIONLOPNLEk[�ER,ADDRESS.TELEPHONENUMBER � / �// <br /> �G1�%�ii l�L•�`97" <br /> "_" q� '_ _"_—" .n�rz <br /> PROJECTADDRESS ""'�"'Oi1 p�i�'�•..� ._ -.-- <br /> �'TOy G��� .�'L� �-,;,,�q,���:������,.t�,„ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FO(TURE OR ITEM FEE NO. T�YPE Uf EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � _ __ aC—AMNDLG UNII'S—H.P. _�_ <br /> BATHTUB _ _ FORCED AIR SYST[MS-13.T.U. M E.�. _ ' <br /> i <br /> LAVATORY(WASH 6ASIN) UNIT HEHT[RS--[�.T.U. �J. _____ � <br /> � -- — - -------�— <br /> ----+— <br /> SHOWER ' CIOTH[SDRYBRS ' <br /> � ' —. —.._. .----- ---. _.._------...--. '- — <br /> KITCHEN SINK 8 DISP � I _ VENTILAT�ON PAN_ . _ ____. � <br /> _'" <br /> T— <br /> � DISHWASHER � RANGE HOOD ' <br /> -- � ------ WATERHEATEH ._.. . ._ _----- - , <br /> LAUNDFY 7RAY - ._-. .. . _- --_.--- -- ; <br /> --T------ -- , <br /> CLOTHES WASHER � _ VJOOD STOVE _ _. __�_ <br /> URINAL METAL FIRFPLAL'E(W00013URNING) _ ' <br /> DRINK�N�3 FOUNTA�N � FIREPLAC[ INSERT . __ �_ <br /> FLOOR DRAW � __ HEAT PUMP _ _ _ _ __ <br /> BACKFLOW�REVENTERS ' GAS PIPIIJG ._ _ ___ ____ � <br /> --- <br /> ---*�------ — � <br /> ROOF DRAINS-RAINLEADERS � EY,HAUST I"Ald <br /> --`- —�--------'--- -�- --��--'�--- _. <br /> � <br />, ��SINK(SENVICE-BAR,FTC.) __�___ —_.—. _ --- -.---- ---- �— <br />. — -----� ------r— <br /> —----- ---- -- - � <br />' � - —__`— <br /> � — ------ - � <br /> _ - — � <br /> ----r-----�-----—'- <br /> -------------------i-- <br /> SU�TOTAL $ ; _ _ SUO TOTAL _S _ I <br /> PERMIT $ , — ---- -_- PGRIdIT $ __� <br /> � TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> nccr��3.��� <br /> .FRONTSETB�CN REAHSEf(lACN SIOESETBRCK rinnr,ner,er�ul7JnE❑ ffl' `}� / <br /> J / • / <br /> U5EZONE� � AREA vncnr+isir� FEES VALUATION FEE <br /> . � ❑ YES ❑ NO gUILDING (/� �/_� � <br /> 1YPEOFCON�T. NO.OFSTORIES OCtuoe'+CY xO.IXowFIUNGuvnS i <br /> cnouv PLUMAING _"___' __ �_ <br /> — <br /> SIZEOFBLDG. FIRESPRINKlEfl5NE0D B�SEMENT IJHCHAIJICAL <br /> ❑ YES '�-1 NO — ---- ; <br /> FIREAIAFMBWD HEIGHTLIMITATION nDDITIONALPL�NCIIECK � <br /> OCGUPANCYLOAD — — <br /> U OTHLH "� i <br /> AE��N -- ---------- 50 <br /> SiATE BUILDING SURCMARGE <br /> MTRKEBY PIANS paaoveoe� CITY OF EVERETT PUULIC WORK$ � <br /> � LOCAL SALES � <br /> o ti . S _y j TAX COOE IS 3105 T07AL � ; 'Z� <br />