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_ APPLICATIC ) FOR CONSTRUCT' �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS i,J ELECTRIC ❑ <br /> 259-8810 <br /> l DEMOLITION � I COMBINATION i I BUILDING I 1 MECHANICAL i pLUMBING SIGN <br /> OWNER IdAILADDRE55 CIiV 21P PNONE fJ�q,��A_ <br /> ,EN-�N�-�-�'L�'��-�/�� �9// CaG�ysvrr�Ip��wq,981n6-s�6� � <br /> MAILAODRESS ��T� zn PMG��� <br /> CAS��UA� �sr. �811 CoGg � g�b-�7 �qD-��l <br /> ARCNRECTOqDESIGNER MAtLPOpRE55 CIiV iP PHON[ <br /> � � GONTRACtOF MNIL nDDR[55 Gliv STIITE LICENSE� � <br /> .�1� DtZ�ln/� �y /�/C. � 70,3� �-✓�,�A ,�/�9�18i33 �Na,�=SZ ll�,.�_ I <br /> IAECMANI�h�CUNiRpGiOF MAILADDFESS CiiY �IP P�iONE STATEUCEtlSEp <br /> �� <br /> PWMBMGCONTRACTOq MAILADDRESS CITY ZIP PMONE SiRTELIGENSE� <br /> L/ <br /> {CO�AGT P IGE OF WORK <br /> �1r <br /> y/ <br /> OESC!IIBE WORK AND SOIIARE FOOTAGE INVOLVEO GOMFf�T PF�q�prypryp pN�pIGNp��^O ��. ^ <br /> �n� 1� ��j���i S��y�Ge...� vv� r'Y r�,� " ���4?A7-3� <br /> �i� ,'.- A �((yi✓ <br /> reoro eouseoFei �Nc i HEFiEBY CERTIFY THAT I HAV[ READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eun�''o7esc�a�iP�►no�NOFaaorEHnisN wNeeiowoan.rac��Twocowes� WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> �or�S_`L A�p�K� oF .��r(�F�/� NOT. THE GRANTING OF A PERMIT DOES NOT PRESU�dE TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> _ OTHEA STATE OR LOCAL LAW REGULATING CONSiRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> raace��nzioNuryyy n APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> (J.�/�`. Q7� � CONiRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ��c�_� <br /> C01JSiPU_C�N L04N LP�IJER.ADDRESS.TftEPHONE NUMBER <br /> PROJECTADDR(/E�SJS/_ ,,,�.�., �3� �a��� <br /> 2 —`"� cnvnus rs iicYr��rre� - <br /> PLUMBING F�ECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILE i� A;C—NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A, <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �— <br /> SHOWER � CL9THES DRVERS —r— <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASl1EF RANGE HO00 T� <br /> LAUIJDRY TRAY ; WATER HEATER <br /> CL071iES WASHER � WOOD STOVE �— <br /> URINAL � METAL FIREPLACE(WOOD BURNINGI —i <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMF �— <br /> � <br /> DACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DR4IN�RAINLEADEfiS EXHAUST FAN ; <br /> SINK�SENVICE—BAR,ETC.) <br /> i <br /> i <br /> i i <br /> � <br /> i — <br /> SUB TOTAL S � SUB TOTAL $ <br /> PERMIT y PEFlMIT � <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: �(�� � <br /> fH011T SETBnCK pE4R oETBACN SIDE SETBACN PLAN CMEGK NU DER FEE RECEIPi NO <br /> e'�� Ic��-l-�iCo <br /> °sE�°�aE eTaREA VALANTSITE FEES VALUATION FEE <br /> n <br /> • '�j•2 ❑ YES ❑ NO BUi�DiN� � /J �C <br /> lYPfpFC051 NO.OFSTORIE$ p��uv�N[v XDNOv.TwNGwits � <br /> cnauo p�UMBiNG <br /> 9Z[OF BLOG. FIRE SPRINNLERS REQ'0 OASEMENT �—" <br /> ❑ VES '.1 NO MECHANICAL � <br /> �_— <br /> OCCUPANCYLOAD FIRERLRRMREOD HEIGpjL1AlI7ATION ADDI110NALPLANCHECK � <br /> FfJC{L�rY <br /> tiEA50N OTHER i <br /> _ STATE BUILDING SURCHARGE 4�ZI <br /> INIAHE pY PLANSAPP WE�BV CITY OF EVERETT PUBLIC WORKS <br /> ��✓� I LOCAL SALES <br /> om� � � ���'- TAX CODE IS 3105 TOTAL <br />