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� <br /> A�PLIGA�'IC�I FOR �ONSTRUCT �N PERMIT � <br /> TU BE COMPLETED IN �LACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS LECTRIC �� <br /> 259-8810 <br /> DEMOLITION COMBINATION X BUILDING MECHANICAL XPLUMBING � SIGN <br /> OWNER h1AILFODRESS CITV TIP PNONE <br /> Timo�l� �/. G���4��� �'1D1 C3a�,er �ve��1� �82.C'il-31If� Z54s-(oLkS� <br /> TENANT � MAIL DRESS CITY 21P PHONE <br /> � <br /> v,�r�n�r ��cc� i�„�I��.,.a ::,��.�;r� <br /> ARCHITECTf1RDE51GNEH h1AI�ADDRE55 qTV IIP PHONE <br /> —� U(A � II� R <br /> GENERALCONTRAGiOR IdAILADDRE55 CITV ZIP PHONE ST�TELICENSEA <br /> —" OwN� Z <br /> MECNANICALCONTRACTOF MAILADDPE55 CITY ZIP PHONE STAIELICENSEp <br /> OwNF,R <br /> PLUMBING CONTRACTOR Mq�L ADDRE55 �h C1IN' ('ZIP PHONE � STATE LILENSE N <br /> ��QM'��IU�n�InCA ��"7 N. ��7 �f.fil7�f.. C� � Ir�� J�II�';)`7��% P,{R1SPC.��hlfiA\� <br /> CLASS OF WORK <br /> � � NEW � ' ADDITION ' ' ALTERATION � qEPAIR ' DEMOLITION . ' WOODSTOVE/FRPL INSEflT � I BUILDING RELOCATION <br /> �//Q�) G'O�/N^TACT PERSON ANG PHONE NO. / <br /> CONTRACT PRICE OF WORK �('�JV v / y : � - _ t� � J(( _sZ� <br /> DESCRIBE WORK AN�SOUARE FOOThGE INCONED �SO <br /> � """"1—'le�, ,h��-�z�u�' ': � <br /> PRoa seouseoFeuaoiNc , I HEREBY CERTIFY �HAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL�ESCRIPTIONOF PqOPERTV(SHOWN BELOW URATTACH FOUR COPIESS� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �or��_ BLOCN 5(c,h oF I I o� C.V G c•' NO T THELGRA T�ING OF A ERMITJDOES NOT PRIESUMEETO G VE <br /> �C('(i�- ��.r� t� AUTHORITY TO VIOLATE OP. CANCEL THE PROVISIONS OF ANY <br /> C �c ,r � � U OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> P�� ��viG. C'��/ � L C� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE A D I C MPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 R A AC. <br /> � <br /> /l�C/.3 2� '� x � -.S-�J.3 <br /> PR0.IECTADDRE$$ �� ��J � � SmN � DnTE <br /> �b <br /> .ItV BUSMESS LiCENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATH?UB ; FORrEDAf�SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYEAS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> � CLOTHES WASHER � — WOOD STOVE � <br /> � URINAL ; — METAL FIREPLACE&CHIMNEY � <br /> DqINKING FOUNTAIN � — FIREPLACE INSERT ; <br /> FLOOR DRAIN � — HEAT PUMP <br /> BACKFLOW PREVENTERS ; — GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS w EXHAUST FAN � � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � � <br /> � <br /> � � <br /> � <br /> SUB TOTAL S ; SUB TOTAL $ / ' �� <br /> PEaMIT $ � PERMIT S � <br /> TOTAL FEE $ ; TOTAI FEE $ � ' <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBACK REAfi�SET�ACK SIDESETBACK PLANCHE�NUM�ER FE�� RECEIPJJJO.�/� <br /> � S/ <br /> ��/ .1X %y �r�� v D 0 <br /> usezoNE LOTAR[A VACANTSITE FEES VALUATION FEE <br /> � BUILDING 30� O ; �d <br /> iVPEOFLONiS.ALLOWABIE TYPEOFLONSTACiOAL occuravcr xoArmvEuixGuqrts � <br /> �I� A0°3 PLUMBING � �T� � <br /> 512EOFBLDG. NO.OFSTORIES BASFMENT MECHANICAL � CrL) <br /> ��cl S-t'c• 2 N� � <br /> OCCUPAYCYLO�D FIRESPRNKLERSFE4'D MEIGHTLIMITATIdJ ADDITIONALPLANCHECK i <br /> / <br /> �I I� N� SPRINKLER <br /> REASON FOR$PRINKLERS <br /> STATE BUILDING SURCHARGE i� � <br /> INTAKE DY PLANS APPROVE�BV CITY OF EVERETT PUBLIC WORKS � � <br /> JI + LOCAL SALES � <br /> Ff � Z� 43 TAX CODE IS 3105 TOTAL — �r <br />