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APPLICATIQ"' FOR C4C".!�TRUCTWN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BJILDING DEPART�VIENT HEATING SYSTEM: d GAS ❑ELECTRIC ❑ <br /> 25�-8810 <br /> ❑ D�:MOLITION J COMBINATION ❑ BUILDIMG �11ECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER Mf�11jDDRESS CITV 21P PHONE <br /> 1 � <br /> _��-O o (-r, -�r� R� P; z z n Z� �. <br /> TENANT MAILADDRESS ��� -/� C�� ^I� J��/ ��/ ����� <br /> ---��'��'J�C'�L/ v !A� %C �L6� <br /> AflCHITECTORDE5IGNER hI�ILA0�RE55 CITY ZIP PHONE <br /> ��3 -�',�2�/ <br /> GE ERALCONTflACTOR MAILADDRE55 CIN /�ZIP PHONE STATELICENSEp <br /> �/�EN�.Q �v3�luc� N �3J5 S C�...7�N�. Ker�T <br /> MECHANIChLCONTFACTOR MRILADDRESS CIN ZIP PHONE STATELICENSEN <br /> k�snnn IAn 's"" fa�no,v�� /�'S�31 G -G7z - loP4 Kl�SPAI�'1C OR�'t� <br /> f'IL. {AN�c ' 'L� S.v <br /> PLUMBINGCONTRAC70R MPILADDPE55 CITV ZIP PHONE STATELICENSEa <br /> �_��� ��� CONTqACTPPICEOFWOflK <br /> ',�. O C= <br /> i�s <br /> �� '� , . DESCRIBEWORKANDSOUAREFOOTAGEINVOWED NTr�TPER DPH NENO. <br /> ; , 10 Jc G'7Z�/09 _ <br /> i ,! '„ <br /> ; _ . . <br /> . - I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> �. , � PROPUS�E-ObUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> A 2^,? . U�L�1 ti PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERN�SHOWNBELOWORATfACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> �or e�xK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> {�.�(^j c� � rT �kr��7 OTHER STATE OR LOCAL LAW REGULATWG CONSTRUQTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PAOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAflCELTAX!.D.I:UMBER CONTRACTORS LAW 182///7���PCW AND 296.200 WAC. <br /> CONSTRUCTION�.OAN LENDER,ADDRESS,TELEPHONE NUMBER n , � ! / � <br /> i <br /> /� X �TUAwv� 1 (flJ� �—/S'—� <br /> PROJECT D�E�S L S�GN a onre <br /> C CITY BUS'NE55 LICENSE ND. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEF CLOSET(TOILET) � NC—A/HNDLG 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 ' CLOTHES DRYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDFYTFAY ; WAiERHEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> T <br /> URINAL ; METAL FIREPLACE(WOOD BLiRNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN �_ <br /> SINK(SERVICE—BAR,ETC.) ; ; <br /> i � <br /> T- <br /> I I <br /> I 1 <br /> 1 1 <br /> � I <br /> SUB TOTAL 5 ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT $ � <br /> . TOTAL FEE $ ; TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK REARSETBACK SIOESETBACN PLANCHECKNUMBEfl FEC- RECEIPTNO. <br /> �/ 3D <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> � YES ❑ NO BUILDING � <br /> iYPEOFCONST. NO.OFSTOp1E5 atuPANtY no.aFprrtuixGUxirS . i <br /> cnoua pLUMBING ; <br /> SIZEOFBLOG. FIRESPRINKLERSREO'D BASEMENT MECHANICAL ' � <br /> ❑ YES ❑ No � <br /> OCCOPANCY LOAD FIRG ALAflM RE00 HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> i <br /> OTHER � <br /> REASON �— <br /> . STATE BUILDING SURCHARGE i <br /> i <br /> INTAKE BY PLANSA 9QVEDBV CITY OF EVERETT PUBLIC WORKS � <br /> �m LOCAL SALES <br /> o e 7—�0� R•j TAX CODE IS 3105 TOTAL � <br />