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APPLIGATIC I FOR CONSTRUCT' )N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �M��� <br /> � <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ,J ELECTRIC _� <br /> 259-6810 �� <br /> DEMOLITION : COMBINATION �C BUILDING T L MECHANICAL I PLUMBING i <br /> OW�JER MAILADDRESS I SIGN <br /> J�i/ �RO� � � GTY ZIP PMCNE <br /> rT l' 2 31 WE Ko2E AV�.� 5.S00 EVCREI'T,uJp SZo/ 38Y�- 4s�¢op <br /> TEN0.IJT IdA1LRDDRE55 <br /> lc�src�oor�fop.�s,t�ucrs i6oa l��.vir;5.sog E Z'Pn 9�Pj"�"E <br /> ARCNITECTOR�ESiGNER MAILp00RES5 - ��K��� / `� �, 25�1- ��36 <br /> CITV 21P PMONE <br /> �/Ol�f�_�(�}HA�/ 608 j0[c9E2f�I�". 5�A7��leXi `/b!d/ 2'12 SZ83 <br /> G[NERALCONT�,pCTOR MAILqDDRE55 CIiY $IP prypNE SiATEL'CENSEe <br /> '.�DG (,pRl� 3/SO,PiC/!R2/��la 5.�.P.�L�VcIE,rr.19 9f005 f�•y000 <br /> !.1[CMANICALCONiqpCTOR MAllAODRE$5 ��n, <br /> Z�P PHONE ST�tE UCENSE M . <br /> P_UhIBINGCONTRACTOR NAl1.A0DRE55 GITY � <br /> Z�P PNONE STATE UGENSE N <br /> CONiRqCT PRIGE OF WORK <br /> �2 '¢�•00 <br /> DE9CRIBE WOPK AND SOUFRE FOO7pGE MVOLVED <br /> WNTACT PERSON AND PHONE NO. <br /> / 3 54• . D i�E E�T/HPI�cuF.,yE,�T !GL o,UG-�L�/o,vE5T5r�4H�i 2�2•5283 <br /> RT �ao,� 7 FI�RT/AG <br /> aRpovo5EDu5r.pp�uaoir�a I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> J OTZrIO� OF �'Z O�F/GE P.1��/LrJ/iL1'�• APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecA�c�esc�ni�anor.oFPHoaeqrv�sHowNee�owo�aynr�thcNnvocowesi WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> I � �oT r—t--=— BLOGN �� oF / u/i OF��/�fZEyTT NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GWE <br /> I ���yE J �f /�I�/-�� p�� 3Z OTHER STATe ORvIOCAL L ON R GULATING CONSTRIUCOT ON OR THE <br /> i PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anace�tnxio r�u�nne�� APPLICATION IS MADE � I COMPLY WITH THE STATE <br />' .SEE /�TT1�C�KE�UT �A �� CONTRACTC) S LAW 18. RC D 296.200 WAC. <br /> �/�,(p r` ' ( ' � <br /> I "Ji15T�y�LC��TT�/�W/Hc/�EPHONENUiOER / <br /> T � q <br />� PROJE 'T AD RESS �� � � V�� <br />� �70 �oc,�Y���. Ftoa2 7 P�r2ri� 5��,,,,�-E <br /> o.« <br />� PLUMB!�YG cnrousvessucvuevo <br /> I — MECHANICAL <br /> NO• TYPE OF fIXTURE OH ITEM FEE NO. TVPE OF EQUIPMENT <br /> WATER CLOSET�TOILET) FEE <br /> ' A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) UNIT HFATERS—B.T.U. M <br /> SHOWER � CLOTHES DFiYERS � <br />' KITCHEN SINK 8 DISP ; VENTILATION FAN � <br />'i DISHWASHER RANGE HOOD <br /> LAUN�RVTRAY ; WqTERHEATER <br />, CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLqCE(WOOD BURNING) I <br /> DFINKING FOUNTAIN � FIREPLACE INSERT � <br />' FLOOR ORAIN � HEAT PUMP —r— <br /> BACKFLOIV PREVENTERS ' GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE--OAR,ETC.i � <br />` <br /> � <br /> � <br /> � <br /> 1 i <br /> SUB TOTAL 5 SUB TOTAL g <br /> PERMIT $ i PERMIT $ <br />� TOTALFEE S � TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br />, FRONiSEiBACK REARSETBACN SIOESETB�CK P�q��CHE NUMB�� FE���, 9a qELE�N;�S�� <br /> S� � <br /> 115E20NE LOTqREA VACANTSITE FEES <br /> VALUATION FEE <br />� _ G YES ❑ NO BUILDING /J Q <br /> iYPF OF WN57 NO.OF STORIES � �% ^ <br /> OCCUCAYCY NO O�NI'[lti4GI1Nrt5 � G d �L <br /> � F � N caoue p�UMBING ' <br />� i <br /> 5�2E OF�LOG FIRE SPRINNLERS PE00 BASEMENT � <br />� 1339 �r• �• � �f L YES iJ NO MECHANICA� � <br /> UCCUPANCY L04D FIRE ALnRM REO'� HEIGHT UM11A710N ADDITIONAL PLAN CHECK i <br /> REnsow � �`f OTHER <br /> �X 3��i . i?�Cq^.�-7 _ STATE OUILDING SURCHARGE // '/T <br /> INTAKE BV PLANS APP VED DY —S� � Y� <br /> CITY OF EVERETT '—�'t�'' <br /> � LOCAL SALES PUBUC WORKS , <br /> DATE I•_ � TAX CODE IS 3105 TOTAL i <br />