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APP�ICI.\Tll : FOR CONSTRUCI ` 1N F�ERMIT � <br />TO BE CONPLETED IN BLACK INK—PLEASE PRI�tT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _--� <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION _ I BUILDING ❑ MECHANICAL ❑ PLUM[31�G y� SIGN <br />OWNER MNLA�ORE55 CITv '.IP PHONE <br />Mo DAS�Gu u�o2 Eve2Gf1� ��f EVFI1etr wA :,qa- qo_;q — <br />TENANT h1AILADOFE ���� • CITY �i ,�,,�lZIP PMONE <br />��1 ntE 14 5 f� i3bV E ��L?���'i r�1"� l��-�" (�'�_ — <br />AflCMITECTORDE5IGNEP h1AILADDPE55 CITY 7.IP PHONE <br />PpCiE.rtT N. ��E ;, ASSoc .�Ssc� 140�` A�� r��., Be��c-Vu� °lBca�S �4(a - 4G1-1 <br />GENEflALLONiRACTOP IA/+ILADDRESS CITY ZIP PHONE ' STAT[LICENSEe <br />M����'L SiC� t ADv�tc�a�NG i��9 Nw�c 99 so-�Tn, mT. ��� q24 • �325 rv�e-(E25A2o3P6 <br />IAECHANICBLCONTRACTOR AIAILADDRE55 CITV ZIP PHONE STATELICENSEA <br />PLUMBING <br />MAI� AODRESS <br />CONTRACTPRICEOFtVORN 4 �,�_��� <br />f�. <br />OESCRI9E WORK AND SOl <br />Damo�lE EK�ST- <br />CITY <br />SiG.�S P�O r.�57A1t <br />�., , . <br />�n,s1��� �� �"1.3 p fz.'CHeVROr.ir uwoM 3�6•�•5 <br />A�`(0 CZ)q.3 g FT• NA��mARK cP�o 3(6r5. inl��A <br />iiU 6 o PS f�. Qa3. 3iu�+5. <br />PROPOSE�USEOF:... JING <br />5F1tvu.e s7A7io.+, SpMe R5 EX�STiNG <br />LEGAL DESCRIPTION Of PFiOPEflTY �SH01YN OELO1'/ OR A1 TACH TYlO COPIES� <br />LOT OIOGK OF <br />,�.E A�"C'rACAAQ� <br />j3208o�. - I -O �S -0000 <br />COHSTflUCTION LOAt! I ENDER. ADDi1E55. TELEPHOt�E NUI.16Eq A��E <br />Zo600 ¢ cN y� O o((, n+w , SE <br />�1{EV(f0^� USA 1/`�+� 541.�"I�e3 <br />PRpJECTADDRESS <br />8 4o'"L E.� e(CGA��� wP�f ��e.��2��rr <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEht FEE <br />WAT[R CLOSET (TOILET) _ _; <br />LAVATORY <br />SINK 8 DISP <br />TAAY <br />WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENIERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />con.mccrae[u REARSETp\GN <br />USE 20NE <br />iYPE OF C�IISi. I <br />SIZE OF OLDG. <br />OCCUPANCYLOAD <br />REASON <br />INT�KE dY <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />,EpT nFEn <br />v s � hzom <br />NO OF STORIES <br />FIRE SPRINNLERS REOD <br />FIFE ALARhI FEO'D <br />PLAH3A �i0VED0Y <br />� �� <br />� 1 .s•. � <br />��y <br />0 <br />�IDE SETB�CK <br />/� <br />VACANT SITE <br />❑ YES r7 NO <br />OCCUG4M1CY q0 OfPN[LIINGU.1:5 <br />LFOU> <br />BASEIdENT <br />i ; '!ES f 1 NO <br />HEIGNT LIIdI�ATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 31U5 <br />PNONE STATELICENSE> <br />CONTALTPEFSONFNOPNONENO. DJNCA�V WAL�� <br />C�v�)�4�� q��� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AflD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 29620� WAC. <br />X p. .l,��C�— �(� lq4 <br />scrverua¢ o"�E <br />NO. TYPE OF EOUIYMEN 1 <br />A!C—AIHIJDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (VlOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />3AS PIPING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE S <br />PLAN <br />�UILOING <br />PLUld91NG <br />MECHANICAL <br />ADDITIO�AL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAFGE <br />PUBLIC WOFKS <br />TOTAL <br />FEE <br />=iar r�o <br />'QS353 <br />FEE <br />�r' <br />i' <br />2 •� <br />� <br />� <br />---� <br />. <br />