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APPLICATIQ`�: FOR CONSTRUCT,'�)N PERIVIIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC U <br /> 259-8810 <br /> IJY DEMOLITION ❑ COMBINATION I !• BUILDING� i.l MECHANICAL I-1 PLUMBING SIGN <br /> MU�eI � .�Yl�Looaess /� GO st� �.�t� �UL' PG✓+14or� U12 � / ZG� <br /> TENANT MAIL�DDRE55 CITV 21P PMONE <br /> � '�- <br /> AflCNITEC OROESIGNER MAILqDDFiESS CITY 21P PHONE <br /> GENER4LCONTFACTOF 61FILADDRESS CITY ZIP pHCNE STATELICENSEaL/�aYl <br /> �� �c�tv /3��(c�eiS �v�c . 7Z6 SE Zpt� �����. OK 9 �2�2 �o3-z3s- i�ss— ���G' <br /> MECNIINICFLCO TRACTOR MAILADOFESS CITY ZIP PNONE STATELICENSEa <br /> PLUMBINGCONTRACTOR MAILAOOFESS CITY 21P PHONE STATELICENSEa <br /> CONTRFCT PRICE OF WORK <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED C^NTACT PERSON�ND PHONE HO. <br /> c e� S�3- z3/- g72S' <br /> J r- •�.� �t-'' e es+�r��r <br /> Zg�� "sav�^�'� G'r I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PflOPOSED USE OF BUILDING APPLICATION AND KNOW THE SA67E TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPFOPERTV�SHOWNBELOWORATTACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT eiocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRF.SUME 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 /> Z �I Z O�l 'Z—t7O " U CO c/ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX ID.NIIMBER CONTRACT <br /> ORS LAW 18.27 RCW AND 296.200 WAC. <br /> ' CONSTRUCTION LOAN LEN�ER,ADDRE55.TELEPHONE NUMBER '� �J <br /> %OOZO �ei r�n � Evaru-r lr�.. ..,_.C. // ,..._ �'� <br /> PROJECT ADDRESS sicvn* e —�E�O �ArE � r'� <br /> � LITV 9USME554CENSE�JO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EC�UIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED Alfl SYSTEMS—B.T.U. M E.A. � <br /> LAVAI'ORY(WASH BASIN) UMiI�HEATERS--B.T.U. M ; <br /> SHOWER CLOTHES DRYERS —T <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRA� ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMF <br /> BACKFLOW PREVtNTERS GAS PIPING <br /> ROOF DRA!NS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � <br /> � � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ PERMIT $ � <br /> TOTAL FEE � ; TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FHONT SETBACK REFR SETBACK SIOE SETBFCK PLAN CME�NU}tOEf�/ FEE RECEIPT N0. <br /> r <br /> `�JQ <br /> usezoNe �ornaen VACFNTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � I <br /> `VPEOFCONSi NO.OFSTORIES oc[uvauGv xooFOWEwr:6uuu5 � <br /> cxauP PLUMBING ' <br /> i <br /> 52E OF BL�G. FIRE SPRINNLEFS REO'D BASEh1ENT MECHANICAL � <br /> r� YES ❑ NO <br /> � <br /> oCCUPaNCv LonD FiRE nlna�,�NEa�D HEiGHi uMiTnTioH ADDITIONAL PLAN CHECK <br /> OTHER <br /> F.EASON <br /> STATE BUILDING SURGHAFGE <br /> MTAKE BY PLANS FPfAOVED BV CITY OF EVERETT PUBLIC WOFKS � <br /> LOCALSALES � <br /> onre TAX CODf IS 3105 TOTAL � <br /> � <br />