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APPLICATIC�'i FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM� GAS U ELECTRIC ❑ --- <br /> BUILOING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION I I COMBINATION � BUILDING Ll MECHANICAL I l PLUMBING ❑ SIGN <br /> OWNER M�ILAO�RESS CITY ZIP PH04E <br /> �«,A,�, � �E.a� 9ja � ✓�Nau� �cJ�av �-rz���� 9So �r yaS- 96z� <br /> TENANT M�IL AOONESS <br /> CITV ZIP PHOtlE <br /> / ��TM Z�p PfIONE <br /> ARCHITECT OR DESIGNE MMl PDDRESS �( ��.j.� ,�a�-6 S� <br /> T>M O(^ �SS�C�A�ILS �s_ �I /K�LANU �ve ��� S7ATELICCNSEt <br /> ��T� PIIONE <br /> GE`NEFALWNTRACTOR /� MAILAD�RESS <br /> l w ^'".0 /{�tr� PHONE STATE LIC:NSE� <br /> MECMANICALCONTFACTOR AIAILADORESS <br /> CITV ZIP <br /> PLUMOING CONTRACTOF MML ADORE55 <br /> CITY ZIP PHONE STATELICENSEu <br /> CONTR�CT PRICE OF WORN �JD/�/I <br /> G <br /> CONTACT PERSON ANO PHONE NO. <br /> �ESCRIBE WORN ANO SOUARE FOOTAGE INVOLVED . <br /> �YE�J � T � SF <br /> r �p S� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED Th!S <br /> PROPOSED USE OF BU iNG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 5��� �M�` (�W G�[,i/.!G PROVISIONS OF LAWS AND ORDINAKCES GOVERNING THIS TYPE OF <br /> LEGALDES�CRIPTIONOFPR,O�PEFT (SNOWNBF.LOWORATTACHTWOCOPIES� NOT THELGRA T NG OF AD ERMITJDOES NOT PRIESUME TO GNE <br /> LOT — Py BLC�ic� /NCKLt� <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 /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> pnRce�rnx i o r+un+ee ,� _ CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> 55'`� ,� O ; � �t�c� r., _ , <br /> CONSTPUCTION LOTN LENDER.ADDRESS.TELEPHONE NUMBFfl J ^� �/a� p� <br /> / �/��� ((l 7 <br /> s�n��m�jr/�;���1�-s`�—' o�ie <br /> PROJECTADORESS � � � ❑n�us�+cssucer+sc�+o <br /> / . �t.n;.� ,�__ <br /> PLUMBING ' � MECHANICAL <br /> y FEE NO. TYPE OF E�UIPMENT FEE <br /> NO. TYPE OF FIXTURE OR 17EM q��—AMNDLG UNITS--H.P. <br /> � WATER CLOSET(TOILET) � <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> r LAVATORY(WASH BASIN) JI,�� � UNIT HEATEflS—B.T.U. M ' <br /> SHOWER I � CLOTHESORYERS - � <br /> � KITCHEN SIP1K&DISP � VENTILATION FAN ' <br /> RANGEHOOD � <br /> � DISHWASHER � _ <br /> � WATER HEATER � <br /> LAUNDRY TRAY � WOOD STOVE ' <br /> CLOTHES WASHER ' , METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL � FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING <br /> BACKFLOW PREVENTERS _ ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN / <br /> i <br /> SINK(SERbICE—BAR,ETC.) � ' <br /> ' � ( ' Jz� <br /> I � ' <br /> SUB TOTAL S � <br /> SUB TOTAL 5 pERMIT S <br /> PERMIT 5 TOTAL FEE 5 ' <br /> — TOTALFEE 5 / � <br /> (�)��'.�'�.�-. <br /> FOR OFFICE USE ONLY: P�ar,cNecKr+ui.�oea FEE J �j� RECEIP�O�/� <br /> FRONT SETOACK REAR SETOAG� S�DE SETOA� j _ J <br /> � ry 1 �J��� fEE <br /> zd � FEES VALUATION <br /> IISE20NE LOTARE� VACANTSITE <br /> n �s�i - ,. '� 3 ��/% ��? <br /> r— I �v V ' � YES �-1 NO Oui�oiH� _ , , ,%; <br /> —�,._ , <br /> ivrE ov cousr No.o sToaies or,cur.�.c+ ��a m o-a�uuvcurus i � <br /> '°�Yri ' PLUMBING ":�„ <br /> � � 3 ^ � <br /> �����`p� FIRESPRINNLERSPEOD �ASE�� MECHANICAL (� �Q�� <br /> y s� ,� v ✓YES l! NO � <br /> NEIGHT LIMITATIOF ADDITIONAL PLAN CHECK ' <br /> OCCUPPNCY�OAO FIRE ALARM REO'D � � . <br /> —J V�� 0 � , ,'.' � . /l� , . <br /> OTHER ' � <br /> i <br /> � <br /> ���'����� STATE BUILDING SURCHARGE _ '� � _ <br /> i <br /> i , <br /> eimr�nv �'�^�+5'����OVFD B'' CITY OF EVERETT Pl1�LIC WORKS ' <br /> `� �1 LOCAL SALES ' <br /> o^i«t 2rs R3 <br /> TAX CODE IS 3105 rorn� /-•'i � � �;�' <br />