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APPLICATIC'"�1 FOR CQfVSTRUCT��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS 0 ELECTRIC .rJ i <br /> 259-8810 � � <br /> ❑ DEMOLITION ❑ COMBINATION iyf BUILDING ❑ MECHANICAL ❑PLUMBING 1 SIGN <br /> aW�E� �o� IAFl80/S Go�cl6A•�t� /h/E-vE�6T1-'PfSZo/ 252-2�5'/ <br /> TENANT MAILAODRESS CITY 21P PHONE <br /> V`�'�v � <br /> AqCHITECTOR0E5!GNER MFILADDRE55 GTV ZIP PHONE �0i4/��Q <br /> �'}4P/L�.S/C7�/N!'• 3�� %z .t ' 9 5�-28'zY <br /> GENERAL CONTRACTOR MFIL 4DGRE55 V ZIP PHONE ATE LICENSE a <br /> C{te✓.vt�tk.Co.�s�w� � s z O a �0`C �- 3G 7 C��rt.�Gt//o,u� <br /> MECHANICFLCONTRACTOR MAIIA�ItRESS C^^,_NnF�Y� A ��jll� /� PHONE STATELICENSEa <br /> L.Jv/w.l! Kf-) rr (/!Y <br /> PWMBING CONTRACTCR MAIL ADDRESS CITY ZIP PHONE STATE UCENSE tl <br /> CONTRACT PR!CE OF WnORN <br /> J�� ��� <br /> OESCRIBE WORK AND SQUAP'c FOOTFGE INVOLVEO �� �[ � / C�/ CONTACT PEflSON AND PHONE NO. — <br /> �f� QJ �Z �Z y <br /> 1��`r�lon -� A� z�u��a SF�2. <br /> I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br /> PqOPOSEO USE OF 0UIl01NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> S�f�L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCJRIPTIONOFPROPERTV�SHOWNBELOWORAI"TACNTVJOCOPIES� WORK WILL �E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or—l---�— BLOCK 3�O oF bl✓• �N„ p�7T_ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> n-F ��- OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE <br /> PERFOFiMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBEF CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> 3�2- 3fi -�o/-mmo7 <br /> CONSTRUCTION LOFN LENDER,AD�RESS,TELEPHONE NUMBER ' <br /> rk�rSl k� 7��'�' 'r'� <br /> PROJECT ADDRESS , I sicryAru� 1 nArE -- <br /> Ol Orn'�CN � CILYBUSM[SSLiCEN5LN0 <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. I <br /> BA7HTUB 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 ; VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAV WATER HEATER ' <br /> CLOTHES WASHEfl WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BUFNIN6) �_ <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> T- <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPIN6 <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAH,ETC.) ; <br /> � � <br /> —�— <br /> � � <br /> SUB TO'fAL $ ; SU5 TOTAL $ <br /> PERMIT $ � PERA".IT S <br /> TOTAL FFE � ; TOTAL FEE $ � <br /> /i <br /> FOR UFFICE USE ONLY: �I-`/� <br /> PRONTSETBACK REARSETBACK SI�ESETBFCK PLANCH CNNUMBER FEE RECEIPTNO. <br /> zo ' 2m 5�- �o� �-��l `1`�`� f?�.a`� /D�S�/. <br /> usezoN� LOTAREA VACANT9TE � FEES VALUATION FtE <br /> �`_Z (a�yp i� YES /�I NO BUILDING �� �j �� I� �' (� i�yQ <br /> iVPE0FC7N5T NO.OFSTOFIES o:C��>vcr naOioWE:uncu'ms <br /> Z 600� � PLUMBING i U� <br /> SREOPBLqG. PIRcSPR!NKLERSREO'D BASEMENT MECHANICAL cJ � (� <br /> � Y ,Q ❑ YES �. NO , � <br /> L O <br /> OCCUPANCYLOAD FIflE�LARMREO'0 HEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> � '�'`� ' OTHER ' <br /> REA50� <br /> STATE BUILDIN�SURCNARGE _',�'� <br /> i <br /> INTFKE BY PLANS APPfi�EO BV CITY OF EVERETT PUBLIC WORKS '�— <br /> �I LOCAL SALES <br /> OATE g/s C�" TAX CODE IS 3105 TOTAL /2� � O <br /> J <br />