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APPLIGATIOC�'FOR COMSTRUCTI'"vN PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS U ELECTRIC U —� <br /> 259-8810 <br /> ! I DEMOLITION I ! COMBINAl'ION X BUILDINu' i I MECHANICAL f I PLUMBING SIGN <br /> OWNER �,1AILAODPESS CIiV 21P SV��;aQ pH04E <br /> �"I`o�wA�os co,�rb�arw �ozza n� �• �Tq•�✓Ts ae•^.c�i,y,��.a�vo WAsr+• 98a33 6t7-97eo <br /> TENANT MqILADDRE55 �IiY ZIP fHONE <br /> �54�/E <br /> ARCMIiECT09DE51GNER I,INLADORGSS CIiV ZIP PMONE — OG <br /> ,P�r,-c - p.e,e,e d' ,assQc. 9�t5 �azv� Ad�• s.e. su�r�/a� /�ier�E,_u��,. y'Soo� -ijpf <br /> GEN ALCO4iRACTOR� MNLADDRE55 CIiY ZiP PHON@ STATEUCENSEC <br /> ������ <br /> 1.'�FGHANICALCONTRACTOR MAIL�DDRESS CITY Zla PHONE STATELICENSEA <br /> PLUM�INGCONTRACTOR h1AILADDRE55 CITY ZIP PNONE STqTELICENSEu <br /> CONTR�LT PRILE OF WORN <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOIVED CONTACT PERSON AND PMONE NO. <br /> ;� , n <br /> _ -7 �C."�'�2� ' CD. �-� a"�- � <br /> �C� <br /> i HERE�Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFOUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �E.a7a�'R�W T� PROVISIONS OF�AWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESC{ilPiIONOFPROPERiV�SHOWNBELOWORATfACHTWpCOPIES� WORK WILL BE COMPLETED W'TH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE Gf,ANTING OF A PF1A71T DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> f�7".�cfJEQ S�,,pdej'�V6� J3j'� OTHER STATE OR LOCAL�AW R�GULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> i� f.GONSaN � AsSa�• l� 7 /� // l� 3/ <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAFCELTAXID.NiiM�ER "� / i //, APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> -��.� •d' � c�'T h��C�C- G�G?f � . CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 2 <br /> CONST UC�NOfR.ACDRE 5 TEIEPMONENIIIA�[R <br /> 2�r2'� r�'I�ltt � ' � �`,. _ 6-✓'-9�_—_ <br /> PROJECT ADDRESS �� �,�_,�+�������E — - n,�e <br /> Levt f%7"AuE. �'v4QE3�- oirr_:s.v�ssvc�r:.:er�o <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-A�HNDLG UNITS-H.P. <br /> BATHTUB ; FORCEDAIRSVSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASMBASW) _ I UNITHEATERS-B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � ; I�ENTILATION FAN � <br /> DISHWASHER � RANG[HOOD � <br /> LAUNDAY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL � METAL FIREPLACE(WOOD BURNING) —�— <br /> ORINKING FOUNTAIN ; FIREPLACE INSERT <br /> PLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS _ GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN ; <br /> SINK(SERVICE-BAR.ETC.) <br /> --�— <br /> i _ � <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S � PERMIT S <br /> TOTAL FEE 5 TOTAI FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONiSfT�N PEARSE7B�K1 SI�ESETBACK PLANCHELKNUhI�'l FE[�`� �S RECEI�Jc/ <br /> n S <br /> �% v <br /> 'JSEZONE _� LOTAREA VACANTSITE � FEES VALUATION FEE <br /> �' YES NO BUILDING . _1 �:t� � � � <br /> 7YPEOFCONSiJ NO.OFSTORIE9 Oteuoe:[v ho�Cxtwt„uArts � �.��� <br /> � '�°ti"' PLUMBING <br /> N -; <br /> SIZLOFBLDG. FIRESPRINKLERSPEO'D BASEME4T MECHANICAL - <br /> .. ,.,�� j V � // 0 f:7 YES ,.'�� T7. <br /> OCLUPANCYLOAO FIREAI�RMR[O'D MEIGHTLIMITAT10= ADDITIONALPLANCHECK !�( <br /> 4' 1 �'s :; 2.R� I � OTHER <br /> R[RSON <br /> STATE BUILOING SURCHARGE ''-I <br /> ��i�nHe ov r�n�,s �oveo�v CITY OF EVERETT PUBLIC YJORKS <br /> ��I� LOCAL SALES ' <br /> �"�` - , -,�3 TAX COOE IS 3105 TOTA� j ;';-�, ;;',- <br /> v JJ <br />