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APPLICATIO" FOR CONiSTRUC71'� N �ERMIT �✓� <br /> TO BE COMPLETED IN BI_ACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: []GAS �ELECTRIC fJ_ , <br /> 259-8810 <br /> I I DEMOLITION I 1 COMBINATION !$�BUILDING i I MECHANICAL C I pLUM81NG SIGN <br /> GWIIER � hfAILADORE55 Cltt ZIP PHONE <br /> _,-�� �F�'"kd25oN�3�oc-I-� Illoo hl� �`Sr• '¢x,--r•e'v� f�1A-. -r'i�3cx� <br /> TRU.NT M�ILADOPESS Cli'/ ZIP PMONE <br /> (�UL.Ar�`� �SGQ�IJ �O�11 ���"11�cR.-�+!'� �N'�'� 1� r'l' uf^(-GSi- �NrQ-' _ <br /> �RCMITEG70RDESIGNER MAIL�D�RE55 CITV ZIP pHpNE <br /> G[IiF.RALGO!liR4QGf1 lAAIL�DOPE55 CITV,/ ZIP CHCNE SiATELICENSE� <br /> � �l \ �JR����t�9-5'L'JS ( 82-1 7�"71 g�-AGKG�k 14£�LC <br /> �,�'r�c �d�-zs; , 9��t� �lc�ST�' i�- � <br /> IdECHANICA�CONTR�CIOR MFILADORE55 CITY ZIP PHONE $TATEIICENSE< <br /> PWMBINGCONTFACTOR MAILADDRE55 � CITY ZIP PNONE STATELICENSEa <br /> ��I l% <br /> CONTR Ci PRICE OF WORK <br /> a� ��_ <br /> �[SCRIBE�VORK M1ND SOUARE FOOTAGE II�VOLVED G Ni�CT PERSON ANO PHONE N0. <br /> _��1� �_ '�2.\UfF^tY- ��r��tG�`> �j G'paK� � � _ 81 'i � <br /> 1�� � _ 7— <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEOUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BC TRUE AND CORRECL ALL <br /> G.E`� PROVISIONS Of LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGaLDESCRIPTIONOFPpOPERTY�SHOWNBELOWORATiACHTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br /> NOT. THE GflANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEI. THE FROVISIONS OF A��Y <br /> OTHER STATE OR LOCAL LAIN REGULATING CONSTRUCTION OR THE <br /> PF.RFORMANCE OF CON;TRUCTION.TI1AT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEHTY TO PERFORAI THE WORK FOR WHICH <br /> APPLICATION IS MADE ANU I �OMPLY �NITH THE STATE <br /> r°Hnce�inx i.o.vuresea CONTRACTORS LAW 18. 7 RCW AND 296200 WAC. <br /> �i(-3o� � <br /> CONSTRWT10Y LOAN LCNDER.ADDNEfiS.TELEPHONE NUMpEfl J /� <br /> �,/';% / �� .2 /(o/�j't — <br /> i.:. <br /> PROJECTA�D��RE��S�Sp�p � (' � �c p��- s�annru �. ore <br /> I V I-��'I �'G-VG�\p'�+� �/`� . .� �l�C-•'�c.�'t 1 � LIrv41l15:NES5liL[45[NO <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPHiENT FEE <br /> WATER CLOSET(1 OILET) A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.iU. M E.A. <br /> LAVATORY(WASIi BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYEFS <br /> _ KITCH[N SINK&DISP ; VEIJTILATION FAN <br /> DISH WASFIER RANGE HOOD --� <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL METAL FIFiEPLACE(WOOD BURNING� <br /> DRINKING FOUNTAIN FIREPLACE I�SERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> _ � <br /> SUB TOTAI. 5 SUB TOTAL S ' <br /> PFRMIT S PERMIT S � <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FHONTSET9ACK RL4RSETBACK S�DESETB�LK PLAtlCHE NUM1IBER FEE PECEIPTNO. <br /> ��ac, <br /> us'ezone LOTFREA VACANTSITE FEES VALUATION :°LE <br /> u YES G NO � <br /> BWLDING �c,QJ i�J.^r <br /> iYPE0iL01lSi. NO.OFSTORtES pCLuveHcv n00ru:r[wnGu'd�5 — �� <br /> G / ,�, ,i aou pLUMBING <br /> SIZEOF�L��G FlFESPRMKLERSHEOD BAS MENT MECHANICAL <br /> /�oo Jqf�. �7.r N� ❑ ves -] No - <br /> OCCUPPNCYLOAD FIFE ALARM REOD HEIGM�VSIITATION AD�ITIONAL PLAN CHECK <br /> �2 � <br /> �4 OTHER � <br /> i�Ensor! i-- <br /> STATE BUILDING Sl1RCHANGE ;`�.; <br /> wTnrcE ov ai.�N,,aPPF��E�BV CITY OF EVERETf PU6LIC WORKS ; <br /> � �h. LOCAL SALES <br /> onTe � � � , � TAX CODE IS 3105 TOTAL I <br />