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APPLICATIC.,�1 FOR CONSTRUCT�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br /> HEA7ING SYSTEM: GAS ' ELECTPIC <br /> BUILDING DEPARTMENT � , U � <br /> 259-8810 <br /> I DEMOLITION ❑ COMBINATION )(� BUILDING I i MECHANICAL i_I PLUM8ING !-1 SIGN <br /> OWNER � A141LA�OFE55 CITV � � � PHO <br /> SoE � Sallo2A Sp�z�a�Y I �SZ9 E�2Err W�F 9�� �t.o-r2_q�_ <br /> tENANi h1AIL�DORE55 CITV ZIP PlIONE <br /> �� c SAupt2q SPEzw`.; 11�2`i 6✓Er2Ect� wA Z�ic� -r f{b <br /> aRCHITECi0R0E51GNER MMLAOORESS CITV IIP PMONE <br /> -�mP2tss�aN oEs�a�vs• - TAmEs n�orr��c 2�{� S -� ca..«aau�a sz' <br /> OENER�LCONTR4CTOR AIqILA�DRESS CITV ZIP PHONE STATEUCENSE• <br /> QW1JC—f'c� Ec�2�'tf wA 4�2a � 252-1200 <br /> IdECN�NICALCONTR�CTOR btAILAD�RE55 CITY 21P PNONE STATELICE Ed <br /> PL�ING OONT�� MAIL AO�RESS QTV ZIP PHONE STATE LIGENSE� <br /> N/k <br /> C@.TRFGT PFICE OF WORK <br /> J 54 08 �- �� � ��'7 <br /> OFiCRiS�LND50U�REFOOfqGEINVOLVEO _ CONiACiPERS�O,NA�P110N�.�,� �4�E-63So <br /> `� ' Pl� L <br /> z,y /00 <br /> 3l2 sc� c � <br /> ��. �,� <br /> � S�O S!_ FT. UAI!=� , 1SN I HEREBY CERTIFY THAT I HAVE qEAD AND EXAMINED THIS <br /> PROPOSED USE OF BUtLDING APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRE�CT.ALL <br /> �1�-(�S lM PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SMOWNBELOYlORATfACHiWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> . �or BLOCK- �F AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS GF ANY <br /> G lZ'K [1� ECIE��['� SQ {�_�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> / \ PERFORAIANCE OF CONSTRUCTION.THAT�AM AUTHORIZED E)Y THE <br /> ( pE1�CO U2'(' IITORTY� 1 OWNER OF THIS PROPERTY TO PERFORN. THE WORK FOR JJHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCh I D NU6IBER CONTRACTORS LAW 18.27 RCW AND 296.20D WAC. <br /> 2 0 � <br /> CONSTRUCTION LOpN IENDEF.ADDRE55.TELEPMONE NUMBER <br /> F�oAJ�IE'� — lL 3 —lo-q� <br /> PHOJECT ADDRESS sc„ni„n� o�rz <br /> L/4AI � �/2 <br /> CIl V IIUI:Y[i('.i::l r�il !A <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOiLETI � � A-C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) — UNIT HEATERS—B.T.U. M <br /> SHOWER � Cl0THE5DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER �" RANGEHOOD <br /> � LAUNDRY TRAY ; WATER HEATER ' <br /> � CLOTHES WASHER � WOOD STOVE <br /> �-- URINAL ' — METAL FIREPLACL-(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> -- BACKFLOW PREVENTERS ; E GAS PIPING APPR�Jf A� <br /> � ROOF DRAINS—RAINLEADERS EXHAUST FAN / � <br /> � SINK(SERVICE—BAR.ETC.) ; <br /> `— <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERI�AIT 5 PERMIT 5 <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: �� , J-�-' <br /> FqONTSETBALK REAPSEiB/•GK � SIDESETOACK PWICNECK11u1.10ER FEE /� /� REGEIPTNO <br /> �` � � • ! 9��o EZ5 ,.� ' � o ' ��D.�� �OX. %✓ <br /> usezoNe �ornaen vacarrtsrte FEES VALUATION FEE <br /> � � �YES . 1 NO BUILDING �(p3 Z ✓�(p 'JO <br /> 1YPEOiC 1157. NOOFSTONIES c'c..�!'.0 an�;rolrzturFUn'.ts <br /> `"" PLUMBING �OQ <br /> �-� 2 3 w � <br /> 9Z[OFBIOG FIPESPRINI(LERSREOD BASE�AEyJ MECHANICAL � CC1 <br /> �3/ SF �IViNG9 ��/ <br /> Lo63 SF. GnReaS � rES � . NO ; � <br /> oCCUPANCv lonD FIRE AURM HEOD MEIGMi LIMITR110N ADDITIONAL PLAN CHECK �d v <br /> Z S OTHER ' <br /> R[ASpN <br /> STATE BUILDING SURCHARGE iv� <br /> u�inHe o+ aur�snr�novco uv CITY OF EVERE7T PU[3LIC WOFiNS �'QJ ; �7�> <br /> J k� LOCAL SALFS <br /> onr� 4�Z�9� TAX CODE IS 3105 TO7AL � �J � � <br />