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APPLICpTIC - 1 FOR CONSTRUCT"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> — --__ _ <br /> ----- -- I <br /> - — _----�1 <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS '.,J ELECTRIC ,J <br /> 259-8810 - - <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN <br /> JcWNEF MrIR ApUNE55 GITV CIP PHONE <br /> 0.��� <br /> iENANT MRIIADDRE55 CRV !IP PHONE <br /> �.IJ. �.R, �Zqoo Fr��•�.D s'T Ev�R�`T 98201� z5°I- W�c <br /> 4N�HifECiORDESIGNER MRILf.DOHESS CiTv [iP PMONE <br /> GENERn�CONTRACTOq MALL ADDRESS Qtt LP PHONE STATE LICENSE x <br /> MECHANICAL CONTRACiOR MAI DDRESS ITY ZIP � PHONE STqTE LICENSE p <br /> �o�s-a� co. � zcn� 51,✓ �yu,u�� 9so� �� � '����4� <br /> PWMBINGCONTRACTOR MAILADDRE55 CITY ZIP PHONE � STqTELICENSEN <br /> CONiRACT PPICE OF WOflK <br /> �8 y 6 Z�' �t.A�R � <br /> DESCRIBEWOqKAND50 A EFOOTpGEINVOLVED GONTACTPERSONANDPHONENO. <br /> ' ' ^�a o u <br /> W�T}-1 CTWo �- O- <br /> I HEREBY CERTIFV THAT I HAVE qEAD AND EXAMINED THIS <br /> PROPpSED USE OF BNLDING APpLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> 'DN S PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �er,n�oescaiaTior�oFvaovearvisNowNeE�owoanTrncHrwocoaies� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEFEIN OR <br /> �oT eixK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITV TO VIOLATE�OR CANCEL iHE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> vnace�rnxi.o.Nurneea P.PPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTF TORS W 1827 RCW AND 296.200 WAC. <br /> GONSTRUCTIONLONNLENDEfl.H00RE5S.TELEPHONFNUMBER <br /> PR0.IECTADDRESS � OO �. ,1w1l � sicrun.0 Iqo Z" <br /> �`f`J CITY BUSiNESS LICENSE NO. <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT "r"EE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB _ FOPCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEA?ERS—B.T.U. M <br /> SHOWER CLOTHES DRVEPS —� <br /> � KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV WATER HEATEP <br /> � CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> . DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEA7 PUMP —� <br /> _ BACKFLOWPREVENTERS GASPIPWG � <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � — <br /> SUB 70TAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT g <br /> TOTALFEE $ TOTALFEE $ " <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK qEARSETBACN qqESETeACK PLqNGHECKNUMBER FEE RECEIPTNO. <br /> U� <br /> use zorve �o*naen vacnNr sire FEES VALUATION FEE <br /> �..' VES C NO � <br /> BUILDING <br /> iVPEOFC�NSi. NO.OFSTOqIES aCcuvnxcv rvaarowswrvcurvrts <br /> GPOUP <br /> PLUMBING <br /> SIZE OF BLDG. FIRE SPRINHLERS FEO'D BRSEMENT MECHANICAI ' <br /> .--. VES -�. NO <br /> OCCUPANCV LOAD PIqE NLARM FEO'0 HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> OTHER <br /> REASON ' <br /> --� <br /> STATE BUILDING SURCHARGE ' <br /> INTANF 9v PLANS FPPROVED BV CITY OF EVERETT PUBUC WORKS <br /> -� LOCAL SALES <br /> onre �I�� �3 TAI(CODE IS 3105 toTn� <br />