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APPLI�A�IC�7 �OR CONSTRUCT""�N PERMIT �� <br /> TC�BE COMPLETED IN BLACK INK—PLEASE PRINT E� <br /> BUILDING DEPAATMENT HEATING SYSTEM: �QGAS �,J ELECTRIC ❑ __� <br /> 259-8870 <br /> DEMOLITION � I COMBINATION x BUILDINGT•L i i MECHANICAL f I PLUMBiNG i i 31GN <br /> OWNER IACIIA��RE55 GTY ZIP PHONE <br /> Jt�N G't�ouP �3l V�THatc��alE•5.sce �V�tcr1T,wlt�tt�2o► sa8-84o0 <br /> 7ENANT MAILpDJ'1ES5 CITY ZIP PIIONE <br /> Pl�u�nu 2T3� we�sro���.�.��o �rE�n'�wh.qPnoi 3ee•a�rs <br /> AqCNI1ECTOP�GSIGNEfl fAAILA0DRE5S GTY ZIP P40NE <br /> Jd�IC�'�Ukht�o�Kl �oo�TAWE�P51.c�• �aE�hTlt,E,W�. 90�ai Z9'L- 8283 <br /> GENERALCONTRACTOR IAAII.qD�ii[55 GTY ZIP PMONE STFTELILENiEk <br /> �Gl. GoftP 3�5o K�WRp7�.� tCt�h� �ELI.EVUE�INJE 9��✓ l��1�ta�o <br /> IdELHINiLFLCONTRACTOR MAILADDRE55 CITY ZIP PIIONE STATELIGENSFa <br /> P'.UIdBINGCONTRACTOR MAILAD�RESS GTY 21V PNONE SiATELICENSEp <br /> ��214,4 W�4 <br /> 5 RIPEWORKANDSOl1AREFOOTAGEINVO�VED CONTACTPEfl50NANDPHONENO. <br /> �74� �t. �Eer oFF►cElteta�.n' INt�ov� ou� Jour� ��rhw <br /> F'IE�T%' XT �GD�R I�� �/�y���AL I HEREBY CERTIFY THAT I HAVE REAG AND EXAMINED THIS <br /> PPUPOSED USE C`F BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI.ALL <br /> IDY O 'Z D IC�i ��• PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGALOESGPIPTIONG'PROPERttISHOWNOEIOWORFTTFCHTWOGOPIES� WORR WILL BE COIdPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �oT--L�� e�ocK �25 oF �fthT 4F ��R�n hOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Vd�UHE 3 O�' pthTS� �E 32 OTHER STATE OH LOCAL LALV REGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> — APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> Pnaee�tnx i o.nuraoea � �1 CUNTRAC?ORS LAW 1 .27 RCW AND 296.200 WAC. <br /> hE� hTTl4GHHC,►JT A <br /> CONSTRUCTIONLOAHLEND[R ��DRESSTELEPMONENUMDEF <br /> �� �Tnc�rlN�� 'f�' � Z.ZI�fS <br /> PROJE T ADDRESS smnnroae onie <br /> 2�a7 Ga-ry'XVE, �I,o01� I� ,1'hi�TiX�L �,,.a�s���ss,.��s� ,o <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEN FEE N0. TYPE OF EQUIPMENT PEE <br /> WATER CLOSET(TOILET) AIC—NHNDLG UMITS—H.P. � <br /> BATF!TUB ' FORCED AIH SYSTF.MS—B.T.U. M E.A. � <br /> LAVATORV�WASH BASW) UNIT HEATER3—B.T.U. M <br /> SHOWEA ' CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAtI <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ' <br /> CLOTHFS WASHER VJOOD STOVE <br /> URV�HL METAL FIR[PLACE('NOOD BUi7NING) <br /> DRINKING FOUNTAIN � FI.9EPLACE INSERT � <br /> fLOORDRA�N � �iEATPUMP � <br /> BhCKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAIVS—RAINLEADFRS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; _ <br /> � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL 5 ; SUB TOTAL S ; <br /> PERMIt 5 � PERfJ1T 5 <br /> iOTALFEE S ; TOTALFEE 8 �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAGN REARSETBALN SiLESFTBACN PLANCNECKNUMBER FEE RECEioTNO <br /> 77 � l 2 <br /> usezor+e totaAen VACFNTS�fE FEES VALUATION fEE <br /> L YES ❑ NO BUILOING � ' <br /> IYPE Oi G0115T NOAF STORIES IX.NCAHCY r.o a mYLLlixcuxrts — i <br /> / �' �; � �POp°Z PLUMOING i <br /> T <br /> S12EOFBL90T.�. FIRESPRINKLERSREO'U 6ASEMENT MECHANICAL � <br /> io oz3 YEs �7 YES �-r,o ; - <br /> OGGUPAN v LOAD FIPE ALARM REC'D McIGHT LIMRATION AODITIONAL PLAN CNECK � <br /> 5' YE S I ; <br /> OTHEP � <br /> REASON � <br /> STATE BUILDING SURCHARGE j <br /> INTAKE�Y PLANS A 'ROVED BV CITY OF EVERETT PUBLIC WORKS � <br /> 1h '1 '2�'S LOCAL SALES <br /> oATe w JS fl.if.$'S TAX COOE IS 3105 TOTAL � <br />