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_ � ___—�a..� <br /> APPLICATIC�'1 FOR CONSTRUCT��1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE <br /> EA-f R�� <br /> BUILDING DEPARTMENT HEATING SYSTEM: nS � C7RiC — <br /> 259 8870 <br /> DEMOLITION �COMBINATION BUILDING MECHANICAL '_ PLUMBING SIGN <br /> OVY�IER IAAILADDRE55 [ITY ZiP PHONE <br /> .-_�k��E �. B�,J �u, r3ox �93G �✓��rr 9g�o3 1 s'Z��� �— <br /> TEIiFNT IAAIL ApDPE55 dTV ZIp PHONE <br /> ARGNITECT OF DESIGNER MAIL hDDRE55 LItY zIP PMONE I <br /> I.�/yiP.Ess,o� nssK,J a�YiP G.4�.�F rdE�E�� fgzv / 25 z �i'2� <br /> GEN�Ery ALCPYtRnCiOA ldA1LA0DNES5 �RV ZIP PHONE STATELICENSEt <br /> (�i�d�%�I� <br /> MELNANI�A�CONiqAGTOfl IAAILADDHE55 GTV ZiP PHONE STqTELICENSE• <br /> CWMBINGLONTPACTOR MAILADURESS GITY 21P PHONE ST4TEUCENSE• <br /> GONTRACT VqIC' WOFN/ <br /> � O"`� 7 �� <br /> OESCRIBE wORK AND SWAP[FppTpGE INV VED CIN�TACT PERSON AN�PMONE NO <br /> E+/`��6iE .4,J� �'t�5� HO��Tic�✓ <br /> � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED �"iHIS <br /> PROPOSED USE OF BUiI�ING APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> S�� PROVISIONS OF LAWS AND ORDINANCES G�VERNING THIS TVPE OF <br /> LEGALOESGPIPTIONOFFROPENTVISNOWNBELOWOFATThCNTWOfAPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOI. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � ,� /�_ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUiHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO P[RFORM THE WORK FOF WHICH <br /> rnaceunzioNuueea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> 3�a 9os- -oa�, -a�o� CONTRA TORS LAW 1 R.27 RCW AND 296200 WAC. <br /> CONSTPUCTIONLOANLENDEE.AD�RESS.T[LEPNONE NUMBEF <br /> G2P.xL + �D/Z/ �3 <br /> PROJ T ADDRESS � •* �� ��� <br /> 03 Gn<-B zr.P�s,N«��,��.,�tN� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> WAT�R CLOSET(TOILET) AiC—A'HNDLG UNITS—FI.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> Z LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � FAIJGE HOOD <br /> LAUNDRYTRAY ; WATEFiHEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> PLOOR DHAIN HEAT PI�MP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS / EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) �_ <br /> � <br /> � <br /> —I--— <br /> SUB TOTAL $ ; SUB TOTAL S �l" <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: �>/.�I� <br /> FPONT SETBACK l REAR SETP� , SIDE SETBACK/ PLA /�uyl�J F'EE / /J�� RECE�a�l�3 <br /> Cl� 7 / �� a <br /> c <br /> use za�e �or aR�n vncnNT srte FEES VAIUATION FEE <br /> — i 1 YES i��. NO BUILDINO /1."1 �(J ���p � (j 'j <br /> 7YP[OICONSI. NOAFST�RIES aa�ioAx[r Newrnvni�xcuxn5 �=y <br /> " � A �"0°3 � PWMBING �j ' (J'% <br /> !i <br /> SIZEOFOID �'RCSPRINKLERSREO'0 BASEMENT � <br /> SEb 3� A�'�+ MECHANICAL �S'� �Ii <br /> 7 S� G/�R O .] YES I� NO <br /> OCCUPFNCYLOF� FlqEAI�RMF[OD H[IGHi-L7IMIiAii(iN ADDITIONALPLANCHECK /� �7 <br /> ,Q _�(D (/�� OTHER <br /> FEnSON <br /> S7ATEBUILDIN65URCHARGE < �. �) <br /> �r�rnhc nr r�nNs nr�r���gyo nv CITY OF EVERETT ruouc woaKs --^-- <br /> �f�" LOCAL SALES <br /> onrr. �p y q3 TAX CODE 15 3105 TO?AL ��� � � <br />� <br />