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APPLiCATIC��I FOR COWSTRUCT. 1N PERMIT � <br /> TO BE COMPLETED IN BLACK !NK—PLERSE PRINT <br /> HEATING SYSTEM_U GAS Q ELEC7fliC _ �'��''/ �"`� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> '�. OWNER � MAILAODFE55 GIN ZIP ��/y�" PHONE <br /> Cti�>�✓ H i�PK LJB�% ,�/,�� ��o � so�,:G�• ��.J�9- l�6) ��t'—/�-� o <br /> TENANT-� MAILADDRESS CIN 21P PHONE <br /> ''f-�9o�-y �7 L�t-�n:LU !/:� O o � <� qdo` i,✓�, 9�'/�-(_ <br /> AflCHITECTORDESIGNER MRILAOORE55 GITV ZIP PHONE <br /> GENERALWN7AACTOFl MAILAUDRE55 CITY ZIP PHONE 5'(ATELICENSEs <br /> MECHPNICALCCK�TPACIOR MAILAJDFE::� CITV ZIP PHONE STATELICENSEA <br /> PLUMBINCCONTRACTOR MA�LAGJRE55 CITY ZIP PHOIJE STATELICENSEN <br /> CONTRACT PpICE OF WORK <br /> DESCRIBE WORN AND SOUAflE FOOTAGE INVOL'/ED � CONTACT PERSON AND PHONE NO. <br /> /nd-/�� a e/ N✓D <br /> d-..c� SP�// � <br /> a.6�.�fi �,6 �-o S j f f . <br /> I HERE CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USEO,��i�9�` �yDr� PROV SIONS OF LAWS AND ORDINANCOES GOVERNWG T�H SRTYPE OF <br /> t0 / <br /> LEGAL�ESCRIPTIONOFP OPERTY�SHOWNBEL0140RATTACHTNOLOPIES) WORK WILL BE COMPf.ETED WITH WHETHER SPECIFIED HEPEIN Ofl <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUf:TION OR THE <br /> `'� t � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � O �� �e// . /n �v��� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br /> W APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P CELTA%1.0.NUMtlER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAH LENDEFi,ADORESS,TELEPHONE NUMBER � w <br /> � i <br /> �' � <br /> PR CT ADDRESS smr+nrune � o"�E <br /> cnv ousn+ess uceHs[r+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE _ <br /> WATER CLOSET(TOILET) � AIC—AIHN�LG UNITS—H.R � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � HEATERS—B.T.U. M � <br /> WER ' CLOT S DRYERS ' <br /> KITC SINK&DISP � � VENTILAT FAN � <br /> � DISNWAS R � RANGE HOO ' <br /> LAUNDRY TR ; WATER HEATER ' <br /> CLOTHES WASH � WOOD STOVE � <br /> URINAI ' METAL FIREPLACE(WO BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> � FLOOFi DRAIN r— HEAT PUMP ' <br /> BACKFLOW PREV[MTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN �_ <br /> -SINK(SERVICE—BAR,ETC.) I , <br /> — � i <br /> � ' <br /> � � <br /> SUB TOTAL S ; SUB TOTAL 5 � <br /> � � PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FQR OFFICE USE ONLY: <br /> FRONTSETBRCH RENBSETBACK �!CE£GTBACK PLANCHECKNUMB[R FEE FECEIPTNO. <br /> use'ONE IOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ftR.7I"rb/� ON�� $OJ� JD � i — <br /> ttPEOFLONSL NO.OFSTORIES occuvar�cv xo.OrmvfwxGuxrt: ' <br /> i <br /> �� � � �Ao� p�UMBING . � <br /> —� <br /> SIZEOFBLDG, FIRESPRINKLERSREO'D BASEMENT MECHANICAL � <br /> �� ;.� ;� ❑ YES ❑ r,o ; <br /> OCCUPANCY LOAD FIRE ALARM FEO'D HEIGHT LIMITATION <br /> AODITIONAL PLAN CHECK � <br /> /' i <br /> � /�//j � ry OTHER � <br /> REASON �� <br /> � STATE BUILDI��G SURCHAflGE <br /> i <br /> INTAKF.OV PV+N PePflOVED BV CITY OF EVERETT PUBLIC WORKS ��_ <br /> 1� LOCAL SALES 5v <br /> on e � _ � � _ 5 TAX CODE IS 3105 T�TA� � <br />