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APPLICATIC�1 FOR CON�TRUCT��N PERMIT �✓� <br /> TO BE COMPLETED !N BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ��GAS ❑ ELECTRIC p —� <br /> 259-8810 <br /> f=7 DEMOLII'ION Ll COMBINATION 17 BUILDING �'MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILA�ORESS CIN 21P PHONE <br /> GEoRGEYrnAi✓ �s-a� .Co.�-,c3A.ev A�E- 9aaoi a.s8 -aiaS <br /> TENANT IAAILA��RESS GITV ZIP PNONE <br /> FRCHITECTORDESIGNEfi MAILADDRE55 CITY ZIP PHONE <br /> GENERALCONTRACTOR IAAILAOORE55 CITY ZIP PHONE STATELICENSEM <br /> �AECHANICALGONTR�CiOR MAILA�DRESS CRY�,,�,�wuep z�a FHONE STATELICENSEa <br /> .ToFp.�. rN�pGYa'vSr�rr�S i9��i-��,/� A�E[o • 92�36 995�-83/S So�t-ESoGG�TH <br /> PLU1d81NGCONTRACTOR MAILqDDRFSS GITV ZIP PHONE STAiEUCENSEv <br /> CONTRACT PflICE OF WORK <br /> y�oo, o 0 <br /> DESGRI�E WORK AND SOUARE FOOiFGE INVOLVED CONT�CT PERSON AND PHONE NO. <br /> 'f7 �/—��3/.� <br /> A�Fi� i✓ / o Lo�'_K <br /> 7S� L�O�! J3 / LJ i HEREBY CERTI�Y THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTIONOFPflOPERTV�SHOWNBEIOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF, <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV'= <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR T'-IE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY T�IE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI�;H <br /> APPLICATION IS tv1ADE AND I COMPLY WITH THE STAfE <br /> anace�rnx i.o.NUMaea CONTHACTORS LAW 1827 RCW AND 296.200 WAC. <br /> a - i - o�� - oon <br /> CONSTRtICTION LOAN LENDER,ADDRESS,TELEPHONE NUMBEfl — � <br /> — x /o -/y -9� <br /> PROJECTADDRESS s:ai��nc Da,)�.r� vare <br /> .Id'i7�i M f) VC • cirrsuswessuc�rvs�r+o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF Ef]UIPMENT FEE <br /> WATEF CLOSET(TOILET) � 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 CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP � I VENTILATION FAN � <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY / WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAI ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BAGKFLOW PREVENTERS a G,�S PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> T <br /> I <br /> I �� <br /> I <br /> SUB TOTAL $ ' SUB TOTAL S ' <br /> PERMIT S PERMIT $ <br /> TOTAL FEE 5 ' TOTAL FEF 5 ' <br /> FOR OFFICE U;iE ONLY: . <br /> FRONTSETBACK REARSETBACK SIDESETBACH PLFNCHEGKNUMBEP FEE AECEIPTNO. <br /> USE7.ONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> if'� YES ❑ NO BUILDING ' <br /> iYPEOFLONSi. NO.OFSTORIES uccUPAutv xoofowEwnGuxns i <br /> caoov PLUMBING i � <br /> i <br /> SREOFBLOG. FIRESPRINKLEfl5RE0'D BASEA7ENT MECHANICAL � <br /> [-1 YES i_^�� NO � <br /> OCCUPANCY LOAO FIRE ALARM RE(l'D HEIGHT LIMITATION ADDITIONAI PLAN CHECK i <br /> i <br /> OTHER i <br /> REASON i <br /> STATE BUILDING SURCHARGE i <br /> INTPKE BY PLANS APPFOVED BY CITY OF EVERETT PUBLIC WORKS i <br /> LOCALSALES <br /> DntE TAX COUE IS 3105 TOTAL <br />