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APPLICATIC^ 1 FOR CONSTRUCT`lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEId: �l GAS ❑ ELECTRIC �,7 <br />BUILDING DEPARTMENT <br />259-8810 <br />! 7 DEMOLITION 1 COMBINATION C; BUILDING )'; MECHANICAL � PLUMBING SIGN <br />OWNE n M'l AOC��E55 C�TV 21V PHONE <br />j�� � E.d,.� K��.C� µ. 1 ��,,,.�s �'� 310 6 R y�'1 � 0 1-i C� �-f- 14 Z o� 3 3�-E -�-"1 �` <br />TENANT MAIIADONE55 CITY 21P PMOflE <br />SY�•^+t hC Y��;OUC� <br />ARLM4ECT OR DES�GNEF MRIL ADDBESS dTY 21P PNONE <br />GENCRAL CONTflACTOP ` MAIL ADDRE>S C�1V ZIP FNONE STATE LICENSE � <br />SY�,.n� 'I�S '(1 �J� J .GJ <br />MECHANIG/J CONT`RACIOP j MAIL PCJRE55 CITY ZIP PHONE STAiE L�CENSE � <br />` �. bS l� Ct� l\�^- <br />PIUUBINGC Tf1ALTOR MAIL DDRESS LITY ZIP PNONE STATEUGENSEY <br />GOI ITRnGT f'RICE OF WORN <br />�� 50.. <br />�ESf.RIBE AK AND �OURRE FOOTRGE ��'VOLVEO <br />PROPOSED USE O:BUI�pING <br />LEGAL DESCRIP110N OF PROPERTY ISH�WN BEIOW ON ATiPCH TWO COPIES) <br />lOT 6lOGK OP - <br />PPRCELTAXID NUMBER <br />ppNGTfiUCTION LOAN LENOER, ADDRE55. <br />00 <br />N0. TVPE OF FIXTURE i <br />WATER CLOSET(TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDflY TRAY <br />CLOTHES WAS�tER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—fiAINLEAO <br />SINK (SERVICE—BAR. ETC <br />NUMBER <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FFONTSETBPCK REARSETBPCN <br />❑SE ZONE LOT ARER <br />NPEOfWN57. NQOFSTORIES <br />S12EOFBLDG FlR[SPRINNLERSR[�'0 <br />OCCUPANCY IOAD FIRE ALARM REO'D <br />REASON <br />INTAME BV PLAN$ APPROVEO �V <br />onr <br />CONTAGT PEPSON AND PHONE NO <br />�-��� L ) �.--l�c� �3�C-Z7 �`l <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF Lf.'NS AND ORDINANGES GOVERNING fHIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPEC�PIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT MRESUME 70 GIVE <br />AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHORIZED BV THE <br />OWNEP OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />A?PUCATION I;, MADE AND I COMPLY WITH THE 5T4TE <br />CONTRA TORS LAW 18.27 RCW AND 296200 WAC. <br />� ��� �.�1��/v�� 'L�t�1�.� <br />L1L_ <br />si;r�ArunE antc <br />N0. TYPE OF EOUIPMENT <br />� NC—A/HNDLG UNITS—H.P. <br />FORCED AIH SYSTEMS—B.T.U. M E.A. <br />i UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />� I RANGEHOOD <br />Vd00D STOVE <br />METAL FIREPLAf,E (WOOD BUF <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING � y ,i ( i <br />EXHAUSTFAN <br />SIDESETBACK PLANCHE�IJyIMBE$i FEE <br />I�J <br />vncnNi sire FE ES <br />Cl YES C� NO gwLoirvG <br />acu?+xn xo a uwcwxc uxns <br />tnouv pLI�MBING <br />AASE�dE11r MECHANICAL <br />L: VES �: 1 NO — <br />HE�GNT LIMiTAT10N ADqITIONAL PLAN CHECK <br />OTMER <br />STATE BUILDIIJG SURGHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />7AX CODE IS 3105 TOTAL <br />0 <br />SUB 70TAL $ / ' � <br />PERMIT $ �S —�!� <br />TOTAIFEE $ _7v ; <br />� <br />�p <br />n <br />�M <br />YN <br />M <br />