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- _- �--_,�. _. _ _ <br /> APPLIC��IC�1 FOR CONSTRUCT""1N PERIIAIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIf•IT <br /> BUILDING DEPARTMENT HEnTING SvsTEn�: ��,Gns ❑ ELEC7Ric til <br /> 259-8610 <br /> ❑ DEMOLITION CI COMBINATIUN ❑ BUILDING ❑ MECHANICbL ❑ PLUMBING �X SIGN <br /> O'NNER Id�IL�DDflE55 pTY ZIP PHONE <br /> /�NDE1CSan� po 3ox 3sz� (3��aE�ivF w�. 5Poo9-38a-/ YS3-l8/� <br /> r��o- _ <br /> TEt�AN7 M�ILAD�RESS CITY ZIP �HONE <br /> /=.a12CNI�o d-�a. S7o2o CV��U�2i=Eti/ Wi4y _FV.Crt 652- 739�/ <br /> ARCHITECTORDESIGNER 1dAILADORESS CITY ZIP PtIDNE <br /> • <br /> GENEqALCONTPACTOR MAILADORESS CITY ZIP PHONE STATEUCENSEa <br /> /��'121E'.Y IVEoNGO . �? O_ �3e}G S,7_6�J �-�f4iHwnoc� (,J�- 9�oy"6 7�6-b'Y3S Ci�'/2l2yiC/co o?�� <br /> MECHANICALGONfRACTOR MMLTDDPE55 GI Y ZIP PMONE STATELICENiE� <br /> PLUMOINGCONTRA.",TOR MAILADORE55 CITY 21P PMONE STATELICENSEe <br /> CONTR�CTPRICEOF\VORK /��^ � �J�G. F(��TON � ��� —"' ��`1 <br /> 00 <br /> �'�-s �--- �% «. <br /> DESCRIBEWORKAN�SO AflEFOOTAGEINVOLV D CONTACTPEiiS011PNDPHONENO. <br /> iN5774GL raM�> 5�/= SICrN —/LLVMVNWT - " <br /> [-D4�� i=�clra. C� E /ST/NG- <br /> PLbN S/GN � Fs�v�-.��`� I HEREBY CERTIFY THAT I HAVE REAG AND EXAMINED THIS <br /> PROPOSED USEOF BUI ING C APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Q����- /?EFl4cE S..S 2 E!9 �'5��� PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTION FPROPERTY�SHOWNBELOWORATTACHT\'lOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPeCIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BIOGN oF AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> SP � ��T-E pL�,� OTHER STATE OP. LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OVJNER OF THIS PROPERFY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCELTA%ID.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> 'L32.- o�� � 62� - aooS <br /> GONSiRUCT10N LOAN LEN�ER,ADORESS,TEI_EPNONE NOMBGR /n/ <br /> O EVEt2G-�_r-�.v wW �Vi?T SUr�2'.'LC � r'�- Jl /l- 2 -�y <br /> PROJECT ADDflESS swr+nrunE o^rE <br /> cirv nusn+ess ucervse rvo <br /> PLUIdBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM PEE NO. TYPE OF EOUIPMENT FFE <br /> WATER CLOSET(TOILET) � PJC—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 /> —�— <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK&DISP ; VENTILATION FAN � <br /> DISHWASHER � AANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) --� <br /> ORINKING FOUNTAIN � FIRFPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; 3AS PIPING � <br /> ROOF DRAi1�S—FAINLFADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,E'iC.) I <br /> � <br /> --T— <br /> , � <br /> 1 ' <br /> — � <br /> — -� <br /> SUB TOTAL $ ; SUB "OTAL S ' <br /> PERMIT S � PERId'i S � <br /> TOTAL FEE $ ' TOTAL FEE $ <br /> � <br /> FOR OFFICE USE ONLY: 2 7 9� <br /> fRONTSETBACN REARSETBACN SIDESEfB�CK PL4NCHECKNU�ER fEE �J RECEIPTNQ.���^ <br /> KJ � � / <br /> usezouE TAREA � VACANTSITE FEES VALUATION FEE <br /> �' �Z .. Z� ❑ YES ❑ NO BUILDING C� <br /> iYPlOFCOtJ57. NO.OFSTORIES atUDaNtY Noorm4FLu4,Urn15 � <br /> caou> PLUMBING i <br /> T <br /> SREOFBLOG. FIRESPRINKLERSREO'D BRSEMENT MECHANICAL � <br /> ❑ VES i i NO — � <br /> OCWP�NCVLOAO FIREILARMREO'0 HEQIGN,,,T,,L�IIAITATION A�DITIONALPLANCHECK � <br /> ""'F�—��� OTHER i <br /> I7EASON � <br /> STA7E BUILDING SURCHA9GE � � <br /> TANE DY PLANS PPPOVEDBY CITY OF EVERETT PUBLIC WORKS i <br /> fOln LOCALSALES � <br /> on e // � 15-9� TAX CDDE IS 3105 rorn� ; <br />