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APPLICATIC" 1 FCiR CONS7RUCT' 1N PERMIT � <br /> TO BE COMPLEI'ED IN BLACK INK—PLEASt PRINT <br /> HEATIN3 SYSTEM: �GAS V EL[CTRIC ❑ � <br /> DUILDING DEPARTMENT . _ <br /> 259-8610 <br /> f7 DEMIULITION ❑ COMBINATION �I BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILADDRESS CITY ZIP PHONE <br /> 3oh,Lro5�tE2 iiasr� -raa S��. s,E c��eErr sBao�F aoG - 3u�- ab98 _ <br /> TENANt MAIL�ODRESS CIT\' 21P PNONE <br /> ARCHITECTOPDESIGHER MFILADDF'e5S CITV ZIP PHONE <br /> DEsi�a L��nsu<tnn�s 9sos-i9avF S,e EJcRE�T" 9gap� ad6 - 33b''- 3<Y6� <br /> GENERALCONTRACT'1R IAAILAODPESS GiTV ZIP PHONE STATELICENSE� <br /> f/�•y,4J BCd„ ib�aaa S��k.� po;,,-� 6GJp, R-,ec�.�'fa^ �eaa3 �sv L/AmGi�n rcl L <br /> MECHANICAL CONTRAC R MA:L AOOPE55 CITV ZIP PNCLE STATE LICEHSE t <br /> 1�s 9� <br /> 4LUMBING CONTflACTOR MAIL AD04E55 CITV ZIP PNONE STATE IICENSE/ <br /> CONTRACT PRlrc nF WORN <br /> �� 00 000 � <br /> OESCRICE WORK AND SOUARE FOOiAGE INYOLVED CONTAGT PEflSON AND PM NE NO. <br /> C�o f T � C [3 �c.pi G o , am �,� - aob -Gs9_ �ysy <br /> � Grdin cp _ O �s � <br /> Q/}p� /f6 O S ��L. i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PflOPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING-HIS TYPE OF <br /> IEGALDESCFIPTIONOFPROPERTV�SHOWHBEIO�7WORATTACHTNOLOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT / eiocb�fv C_eT // . PLl�7" NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OF ANY <br /> O F EUERE t r j)F CCS , tJ 0 C� /? � OTHEii STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> Pi9- E G8 R¢coRs e� Snc�iOma Co.in� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.Nl1MBEfl CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LE�^FR.ADDFESS.TEIEPMONE NUA'BER �// /� 1 <br /> 4J/�s/�. Fi�2s� r; Dca�i� -Cvnn�nna y�`o�" "�, �v�,.��. /a�o�9S� <br /> PROJECT ADDRESS svr+�roec o.,e <br /> �/ - �LE�vwmo0 ��E�Ur��JE�GFTT c;rvouswcssiiccrvstr+a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIHNDLG UNITS—H.P. <br /> FA�HTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEA�ERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HFATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> UFiINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRA�'. � HEAT PUMP � <br /> BACKFLOW i'REVENTERS ; GAS PIPING <br /> � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S SUB TOTAL 5 ' — <br /> PERMIT 5 PERMIT 5 � <br /> TOTAL FEE S TOTAI FEE $ ' <br /> FOR OFFICE USE ONLY: G <br /> FPONTSF.TBAGK FEARSETOACK � SI�ESEiBAC� � PI.AI+CNE.��B R iEE - � � RECE��{O�� <br /> � / � �r <br /> , (l <br /> US�NE � LOT AREA�� VACANT SITE FEES VALUATION FEE <br /> -� –; VES � NO ' �' <br /> BUILDING Z (a � <br /> TYPE 0!CONSf. NO. F STORIES aN^+'¢r r.i o���.stu�•auvns -- � � i <br /> 2 '�'� PLUMBWG / ���`)-i <br /> SIZE Of BLDG FIRE SPPINKLERS REO'D BASEM1IENT � <br /> 3'� 'F' S t ❑ YES ;✓p A�ECHANICAL �� 1 <br /> 3� S�G^12 <br /> OCCUPANCVIOAD FIREAlAR11REOD MEIGMTI�NITqTIOt�y ADDITIONALPLA�CHECK T <br /> 2 � � 20 <br /> � OTHER /� � ' � <br /> i <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> i <br /> INTAKE 9V PLANS APry+oveo o,• CITY Of EVERETT PUBLIC WORKS i �' <br /> `J kI� LOCAL SALES � <br /> DATE 3 Cl� TAX CODE IS 3105 TOTAL � I <br />