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APPLICATI�� FOR �ONSTRUC7'`'►N PERMIT � <br /> TO BE COMPLETED IN RLACK INK—PLEASE PRINT � I <br /> BUILDING DEPARTMENT HEATING SYSTEM: IJ GAS C,1 ELECTRIC ❑ N �L � <br /> 259-8810 <br /> ' I DEMOLITION Ci COMBINATION BUILDING f i MECHANICAL 1 PLUMBING J SIGN <br /> ow��En rAa�noorvess vNome <br /> M� � ��� �� W�, ��,��T .,Pq�y ��,� Z�o <br /> TENANT ld41LADDBESS GtY ZIP PHONE <br /> ARCHITECTOROESIGNER MAILADDRESS CITV ZIP PHONE <br /> GENEP4LCONTRACTOR h1AILp00RESS PHONE STATELICENSEv <br /> Mtu� ��72,�� Y,ox 6645� SeAr2� qg/�6 zv�-noz kr�-r.��rz�f gc,s <br /> fdCCH�NICAICONTRACiOR MAILAODPE55 .'ITY ZIP PHONE ST�TELICENSE< <br /> PLUhIBINGCONTflACTOR lAqILADORE55 CITV 21P PHONE STA7ELICENSEa <br /> CONT ACT PRICE OF WOFK <br /> �' ���d0 <br /> �ESCBIBE YIORK AND SOU�RE FOOTAGE INVOLVED WNTACT PERSON AND PHONE�10. <br /> T�.i5rAt4, CoNcr.t-rE Fo2H �L scUGnAn� <br /> Fpe 20' �Ibl,rt' pp� MARK ��-►-IlA/tD Z`h3-IIpZ <br /> i HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF dUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNI�'G THIS TYPE OF <br /> LEGAL�ESCRIPTIONOFPROPbRTY�SNO'NNDELCWORq7TpCHi1NpCOPIES� WORK WIL� BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING OF A PERIdiT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW HEGULATING CONSTRUC'�ION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO P[RFORM THE WORK FOR WHICH <br /> �AqCELTAXID.NUMBER — APPLICATION IS MADE AND I CO�dPLY WITH THE STATE <br /> CONTRACTpRS LAW 18.27 RCW AND 290.200 WAC. <br /> CONSTRUCTION LOFN LEN�ER.ADDRESS.TELEPHONE NU�dBER �i/ �� ^ <br /> !/1 ,N �� <br /> \`1'v1�–.� <br /> PROJECTADDRESS ":..:°10f�� Q� '� --� .�����6'��� <br /> Cirv OUSi'JE55 LiCHbB NO <br /> PLU:SBING MECHANICAL <br /> NO. TVFF OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> _ WATEA CLOSET(TOILET) AiC—A�HNDLG UNITS—Y.P. <br /> BATRTUB FURCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M <br /> SHOWER ~— CLOTHES ORYERS , <br /> KI7CHEN SINK&DISP � ; VENTILATION FAN <br /> DISHWASHER FANGE HOOD � <br /> --r— <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ' <br /> � <br /> URINAL ; METAL FIREPLACE(WOOC BURNING) <br /> DRINKING FOUNTqW FIREPLACE INSERT <br /> _ FLOOR DRAIN HEAT PUMp —r— <br /> _ BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—NAINLEADERS EXHAUST FP.N <br /> SINK(SERVICE—BAR,ETC.) � <br /> � SU8 TOTAL $ ; SUB TOTAL S <br /> PEFMIT 5 PERMI7 5 <br /> TOTAL FEE S ' T07AL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiB�CK FEARSETBACK SIOESETBhCK PLANCNEC�NU�I.+p ER F[[ RECEIPTf10 <br /> `/O`76�S <br /> USEZONE LOTAPEA VPCANT'SITE FEES VALUATION FEE <br /> ._J YES .=I NO BUILDING <br /> TYPEOFCONSi NO.OFSTORIES oC[Uear;tv r�p.aro�rFm�cv,as _ � C� ��� ' <br /> cnc�r pLUMBING � <br /> SREOFBLDG. FIflESPRINHLERSREO'D BASEIAENT MECHANICAL <br /> ❑ YES ❑ WO <br /> � <br /> OCCUPANCYLCA� FIflEALARMFEOU HEIGHTLIMITAiION ADDITIONALPLANCHECK � <br /> i <br /> ;-.,N—"'_— _- OTHER � — <br /> ,. I <br /> STATE BUILDWG SURCHARGE i <��� <br /> IH f�F:L���.___""".T.-'.—�—' _ <br /> � , sA. �tGVEpBV <br /> I ,, . CI7Y OF EVERETT PUBLiC WORKS <br /> �)'�i !_OGAL SALES <br /> =�•„c_r- �. , TAX CODE IS 3105 TOTAL j� � SZ <br /> —... .__.._ __... � <br /> - -- - r,e.:��ra;��,.r�r - <br />