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APPLICQTIC"�� FOR CONSTRU�GT"�7N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEA5E PRINT � <br /> ,�,��., <br /> BUILDING DEPARTMENT HE�TING SYSTEM: :=j GAS '� ELECTRIC U <br /> 259-8810 <br /> DEMOLITION � i COMB;NATION X BUILDING ; 1 MECHANICAL i ! pLUMBING SIGN <br /> 01YNEF ldN�ADpRESS CITV <br /> Z�P PHONE <br /> Robcr± Uq.i c 1202 Lo..,6a� <br /> reNnrvr �.inanooaess d �-�err+�F y£ Zal (2oG� Zsz - �33z <br /> CITY ZIP PHONE <br /> ARCHITEGTORDESIGNER �,�pIL � CITV <br /> �`���l�l11b l41� ��P PHONE — <br /> vWY InM <br /> GENERALCONTRACTOR CS�uc Rsg�o�,[L <br /> l.1All FDDq .��,W. �M Clry ZIP PHONE <br /> AR M,i!�7 STATELICEHSEk <br /> ME6i1pNIC4L-COPl7ptf�}pq h7AILA00RE55 �+•an CITY <br /> ZIP PHONE fTATELICENSEa <br /> A�UM9INOCOM{R�C-TOq- MFILADDRESS GTV <br /> ZIP PHONE STATE LIGENSE p <br /> jGNTR�LT PRICE OF WORK <br /> �S J ri��°. <br /> DESCRIGE WOEK�ND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PMCNE NO. <br /> Z7 X 37 PoS T �r� G r o��' <br /> �99�__ <br /> Pnoao�eouseoFem�owc i HEREBY CERTIFY THAT I HAVE READ qND EXAMINED THIS <br /> �_nr�r,.r APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCFIPTIONOFaROPERTY�SHOWNfiELOWORATTACHT\VOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or jZ 3 3 Pi_�K G40 oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUiHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> — OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORA1ANCE OF COIJSTRUCTION.THAT I AM AUTFiORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anace�rnxi.o.nur.�eea AP�'LICATION IS MADE AND I COMPLY WITH THF STATE <br /> s�+�3- Zyo-0 3z- o0o f CONTRACTORS LAW 18.27 RCW A�D 296.200 WAC. <br /> CONSTflUCT10N LOAN LENDE0.ADDRESS,TELEPHONE NOIdBER � <br /> �zOZ �.O �+Qr Ve�e <br /> PROJECTADDRESS s�ct u�e �f-IL -9S <br /> .3S77-OU-UO-O� on�e <br /> CIiYAUS.�ESSLICHLd 1A — <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT <br /> _� WATER CLOSET(TOILET) FEE <br /> � ' NC-AiHNDLG UNITS-H.P. � <br /> _�•� BATHTUB � � FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � —�NIT HEATERS-B.T.U. M ��� � <br /> HOWER � Cf.p HESDRYERS �— <br /> KI HEN SINK 8 DISP / VENTIL ION FAN � <br /> DISH SHER RANGE H D <br /> LAUNDR TRAY.' ; WATER HEAT_fi � <br /> CLOTH[S WASHER - WOOD STOVE � � <br /> URINAL ME iAL FIREPLACE OOD BURNING) � <br /> DRINKING FOUNT N FIR[PLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTE GAS PIPING <br /> ROOF DRAIfyS-RAWLEAD S EXHAUST FAN;� <br /> _ SINK(SE GICE-BqR,ETC.) � � <br /> � <br /> � � i <br /> � — <br /> � � � <br /> �— <br /> ____ SUB TOTAL $ SUu TOTAL $ <br /> PERMIT 5 � PERMIT c� ; <br /> TOTALFEE $ TOTALFE[ S <br /> FOR OFFICE USE ONLY: <br /> FRONiSET�ACH / REAqSFiqqCK / SIDESETBFC� PLAflCHE�KN ��R FEE � /_O qEC[IPiNO. <br /> �� �� <br /> ` � � /r <br /> USEZO Ln7AREA VACANTSIT <br /> �� ��� � FEES VALUATION FEE <br /> ��1 YEa' �:�!NO <br /> irvEOFCUNSi. NO.OFSTORIES BUILDIP;G — III/ /=/� ' L�.� <br /> o�c.r>�mv raa�n'.r:ue,eur.0 _� � <br /> ruau. <br /> � v_ PLU�d81N3 ; <br /> i <br /> S/IZ�EOF�LLd. FIFESPRINKLERSREOD B�SEMENT � <br /> v'/ SF. i . YES 17Np MECHANIC4L <br /> OCCUPANCYLOAO Fipen�nqn��eo�o HEIGHT�Ih+17ATi� / ADDI710NALPLANCHECIC � <br /> �l <br /> FlE�SGN C/ OTHER ' <br /> STAIE BUILDING SURCHARGE —�:- <br /> ��,T�HE�v PLqNSAPPR1O'V�EDOV CITY OF EVERETT <br /> �/� LOCAL SALES PUBLIC WORKS <br /> on,e e?��¢� 9S TAX CODE IS 3105 TOTAL ��'I i � <br /> G <br />