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APPLICATIQ ' FOR CONSTRU�CT�"-`N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �EI.ECTFIC ❑ <br /> 259-8610 <br /> ❑ DEMOLITION ❑ COMBINATIOIV �BUILC�IhG ❑ MECHANICAL <br /> OWNER ❑ PLUM9ING ❑ SIGN <br /> �^��Q �+ (� A1r11L ADDRESS !� ��T� n <br /> �{`f��J A• IJ��� �(�?SfF/V ��CNI�T I�S�I {I �r L. Sr �ZIP_,..� /� �PHOCNEA /� <br /> TEN�NT . _ U'C7('y�CC W1� L,L1OL� /��^'��OZ <br /> - A1nll nODRE55 QTv llp <br /> PMONE <br /> ARCHIiECTOR0E51GNER MNIADDRESS CITY Z�p <br /> ������ PHONE <br /> GENEPALCONTRAC70R MAILADDRE55 CITY Z�p <br /> J/��t�+ PHONE STATE LI/C�EpNSE MJ /�' J <br /> MECHANICAICONTRFCiOR MAILADDRESS ____ ���l1EST/IJ /�,3R/`/ <br /> CITY ZIP PHONE STATE UCENSE■ <br /> 5�9UC/3 <br /> PLUId81NGCONTqqCTOR MAI�A�DRESS CITV <br /> ']J n f/ Z�P PHONE STATEIICEN5E9 <br /> ll-,T �/ <br /> CONTPACT PflICE OF�"pqN <br /> DESCflIBE ORKANOSOUAREFOOTAGEINVOLVEO ^ <br /> ES•%7L71I� I� �O S.c��Ti CONTACTPEq50NAC��f� �S ' <br /> J i¢6�![ � <br /> VROPOSEDUSEOFBUILOING � HEREBY CERTIFY THAT I HAVE READ AND EXAMI�:ED THIS <br /> �" APPLICATION AND KNOW THE SAME TO BE TRUE AND COR9ECT.ALL <br /> PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS 1YPE OF <br /> LEGALDESCflIPTIONOFPROPERTV�SNOWNBELOWORATTACNTWOCOPIES) WORK WILL BF COMPLETED WITH W'iETHER SPECIFIED HEREIN OR <br /> �°T � u�ocK op 5l•� 3��! NOT. THE GAANTING OF A PERMI' i.pES NOT PRESUME TO GIVE <br /> AUTHORI�Y TO VIOLATE OR CANCEL THE PpOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CC)NSTRUCTION OR THE <br /> 1 f PERFORM1IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> V OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTq%I.D.NUMBER n APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> V CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> CONSTflUCT10N LOAN LENDER.AD�RESS.TELEPHONE NUh18Efl <br /> 51/. ��, F3cRlFtSCG S��l�•-�?�( 9 –�=1–L� <br /> PROJECTApD SS �� r E C <br /> (� • �LLI�'(c W��1 y o��� <br /> ♦ 15iN[SSLiCENSEND. '— <br /> PLUMBING CHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT <br /> WATER CLOSET(TOILET) FEE <br /> ' A/C—A/HNDLG UNITS—H.P. � <br /> I BATHTUD ' FORCEDAIRSYSTEMS—B,T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CIOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWqSHER � RANr,E HOOD � <br /> LAUNDRY TRAY ' ; WqTER HEATER , <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> ORINKIN6 FOUNTAIN ; FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING , <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> � , <br /> � <br /> i <br /> � <br /> ; � <br /> � — <br /> � ' <br /> SU3 TOTAL $ � � <br /> SUB TOTAL $ � <br /> PERMIT S � PERMIT $ ' <br /> TOTAL FEE g � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN qEAflSETBACK SI�ESETOACN PLANCH KNUTABEfl FEE RECEIPTNO. <br /> �/ � � S / ����-�° '� � �U/J <br /> usezopr+e LOTA`REA vncaNrsire FEES VALUATION PEE <br /> !�'�'� c7 � ❑ YES ❑ NO BUIIDIWG �i <br /> 1YYEOFLONSL NO.OFSTORIES o[cUonscv NOOfunflbr�GUFiI3 ?� �7v 'C�U <br /> �d� � �,p�P ' PLUMBING ' <br /> i <br /> SRE OF OLDG � <br /> ISZJ Sf Y FIRESPflINItLER5RE0'D B�i5Eh1ENT i <br /> � S Gn2a[,�., � YES [�p MECHANICAL � <br /> OCWPANCY LOAD FIRE ALARM qE0'D HEIGNT LIMI TION / AC9ITIONAL PLAN CHECK � <br /> ND A DG 1 <br /> REASUN OTHER /��C� <br /> v� <br /> � STATE BUILDING SUflCHARGE ��— � <br /> INTr1KEBY P�ANSAPP,ROyEDBY CITY OF EVERETT PUBLIC WORKS <br /> J N LOCAL SALES D�OD <br /> DATE ��h.�/q3 TAX COOE IS 3105 rorn� � <br />