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APPLICATIO�'"�fJR CONSTRUCTIt`"'1 PERMIT � <br /> TO BE COMPLETED IN BLAC( fNK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: f]GAS ❑ ELECTRIC U <br /> 259-8810 <br /> (1 DEMOLI�ION f 1 COMBINA710N I I BUILDING f 1 MECHANICAL I 1 PLUMBING �SIGN <br /> OWNEP MNLAO�BESS CITV ZIP PHONE <br /> �R� /yIA/✓. �aeP /.zyo� cE 34�'`'r� RFc�r-✓uF- 9�30�� " �/3-/ oi/ <br /> TENANT MAII.ADORESS CITY Z�P PHONE <br /> �� ' / <br /> /JP uc'AniERS %= �3••M Ev�,c�-n� N1a� � y��� �vc:CF�T <br /> ��/g-• Co07 � <br /> MCIIITECiCRpE51GNEP MAILADDFESS CIIV 21P Pk10NE --{+..Ta <br /> �ovSc�✓ _ �6sv� �6z"'`/�c sE .�.v-� / 98os ,7oc� 2 �S- �7z'� <br /> GENERALCONiRACTOR M�RAODRESS Cltt ZIP PHONE SiATELIGENSEk <br /> �aP/c.r �tF�-r' �v. iL�2/_ /yi��,�'icrB v SPc.vv'�'7 ,4q�-f,C. 9FZ7`S� _355-0�z�/ .r'MOAr,EAo 73LX'i <br /> MEC4�NILALCONiqACTOR MAILAD�RESS QTY IIP PNONF ST�TELICENSEb <br /> PLUMBINGCONTRFCTOR M41LA[tORESS CRY IIP PHONE SiATEIIC[NSEa <br /> GO ACi pRICE OF WORK <br /> o� <br /> V � / .1/ �F� �j' Qp— . <br /> D SCRIBE WORH ANO SOU�RE F00 GE IN OWEO�— CONT�CT PERSON FN�PNONE NO. <br /> �.J✓sr.� � c.� � , .s vsa�eo/� � <br /> 5" //� .�v '�'2 • �i .SL% �7� ?S�-o8z�/ <br /> FIA/✓A/F�- /PS; /N! '/�U �'��/II�I�-� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnoroseo use or ounowc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> ('L�iq.N�.O-S PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�L�ESCRiPTIONOFPROPERiV�SNOWNBELOWOR�TTAGIITWOCOPIES� WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES MOT PRESUME TO GIVE <br /> �or oiocK oF 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 /> � AT� � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> rnnce�mxio.Nurnoen <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ^Qo -/-oZv-oou7 -/8�- C5=/• Uc-�7-JD CONTRACTORSLAW18.27RCWA?!D296.200WAC. <br /> GONSTRUC710NLOANLENDER.AOORESS.TELEPHONEIJUId�ER <br /> , �-Lo ..yY <br /> PROJECT ADDRS^�S �7 sici mm�e uur <br /> /,�03�/+q - VC;�r7' �naL /" ` cirvnusiarssucrrvsi:nu — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. ; <br /> BATHTUB � ; FORCED AI�SYSTEMS—B.T.U. M E.A. �— <br /> LAVATORY(WASH B�SIN) UNIT HEATERS—O.T.U. M ; <br /> SHOWER � CLOTHESDRYERS —�— <br /> KITCHEN SINK 8 DISP � i VENTILATION FAN � <br /> DISI�1'/ASHER � RANGE HOOD --�— <br /> LAUNDf.Y TRAY � WATER HEATER <br /> CLOTHES WASHER �— WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSEI3T � <br /> FLOOR DRAIN I�IEAT PUMP <br /> BACKFLOW PREVENTEFS i GAS PIPING <br /> ROOF DRAINS—RAINLEADERS —�— EXHAUST FAN <br /> SINK�SERVICE—BAR, ETC.) ' <br /> � _ <br /> — <br /> � ' <br /> � <br /> � --i— <br /> SUB TOTAL 5 ; SUB TOTAL $ <br /> PERMIT $ �— PERMIT $ ; <br /> � TOTAL FEE $ ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSEfBACH PE4RSEiBACK SIOESET64CH PL4NCHECKNUMBER • FEE �. 5— RECEIPTNO. <br /> �� / � i <br /> Use NE �oT,v�En vnCn�irSire FEES VALUATION FEE <br /> rll�j rl YE� f) NO pUILDING ; <br /> iYPEOiCONSi NOAFSTOiilES amrnatr xnmauFwncuxn5 <br /> �� �:? <br /> �a'0r PLUMBIh3 � <br /> i <br /> 512EOfBlUG. FIRESPf11NklEF5RE0'0 O�SEMENT MECHpNiCAL ---�-- <br /> O YES f_I NO <br /> OCCUPANCY LOAD FIRE nLnnM fiEoO HEIGNT LI�dITnT1oN ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER � <br /> PEASON � <br /> S7ATE BUILDING SURCHMGE i <br /> ;_L� <br /> INi�Y,E 9Y PL�N, hPPROVEU BY CITY OF EVERETT PUBUC WORKS � <br /> /�11}� LDCALStiLES ' <br /> o�rE ,ag_�y TAX CODE IS 3105 rorn� C ' � � <br /> � <br /> Rx�. <br />