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APPL1��47`1��^l FOR CJtrlSTRl1CT'_'t� PERIVI�T /,� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �ien <br /> � <br /> BUILC'ING DEPARTMENT HEATING SYSTEM: ❑GAS � ELECTRIC ❑ � <br /> 259-8£i10 \/ <br /> C7 DEIdOLITION %,' COMBINATIOM I BUILDING ;7 MECHANICAL L I PLUMBING ❑ SiGN <br /> OWNER �4IL�D�RE55 CIiY 2iP PHONE <br /> ��._.-���.� N �du� Pe�� ���� ��,���k �o� 45��� �Fl 7 I Rz,� <br /> TENFNT lAAII��DRE55 CITY ZIP PHONE <br /> U <br /> ARCHITECTCRDESIGNEP IdqlLq��RESS CITY ZIP PMONE <br /> -C'2E Q��yr, I K I <br /> GENER4LLOM1TFACTON M4ILADDRESS pTV ZIP PHONE STAFLICENSEb <br /> �-��1-�.u��-s.�; ��B �3C�1� ��ert#. �A�', g 8__�a�_ 3 �1-I- � 1 y <br /> MECHANICAI G`NTRAGTOR ���L ADORE55 qTY ZI—� PHONE STATE LICENSE< <br /> �� <br /> PLUTABINGf.pNT=4CTOR MAILADOfiESS CRY ZIP PHONE STqTEIICENSEa <br /> GONTNACTPRICF OF WORN <br /> �ESCRI�SOU E FOOTAGE RJVOLVED CONT Ci oE SON AND P�ON�NO <br /> l�,z �..� j�lo AAa,�,,, 3 -� �8�{ <br /> � , � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUII�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL� O/E�S�C�RI��� NOFFqO qTY�5H01YN8El01YORA//r�/CHTWOCOPIES) WORK WILL BE COMPLETED WITH WHEiHER SPECIFIED HEREIN OR <br /> �or-t-Y��J— 8LC^.K �d� oF �"������-5� NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO G '� <br /> AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> _ OTHER STATE OF LOCHL LAW REGULA7ING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> � � �� a�� OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH <br /> PFRCEITFYIA.NUTABER APPLICATION IS MADE AND I COMPLV WITH THL STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � NSTRUCTION LOAN LENpER.AD�RESS.TELEPHUNE N@ABEq ` �yY\ <br /> \ - - �-��'J. <br /> R OdECT i\DDRESS /'�f simuruee a�E <br /> l /�/ �w��� � GIlVBI151NE55LICCk= <br /> � L k0 <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLGSET(TOILET) A/P—A/HNDLG UNITS—H.P. <br /> �_�_ 6ATHTUB - FORCED AIR Sl'STEMS—B.T.U. M E.A. <br /> LAVATORV(WA�iiBp51N) _ i UNITHEATERS—B.T.U. M <br /> SHOWER � CLOTHESORYERS <br /> �_ KITCHEN SINK&DISP �� VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD --�- <br /> IAUNDRY TRAY ' WATER HEATER <br /> CLOTHES WASHEF= WOODSTJVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINI(ING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PU'AP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; <br /> �SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> SUB TOTAL S i SUB TOTAL $ � <br /> PERMIT S � PERMIT $ <br /> TOTALFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSE�GK / REFRSHtlAr�K, SIOESET�ACK PLANCHECKN�l.1�ER FEE� RECEIPTNO. <br /> �� __ 7 r� � �:. 73 -� O 3v Ci� <br /> usEzo LO7AflEA VACANTSITE FEES VALUATION FEE <br /> —� ❑ YES !^� NO BUIL�ING Sp ' � ��� .. � <br /> iYPE0FWG5T NO.o STOPIES acuradcr xo.ovowflUa;un¢ <br /> flOJ� PLUM9ING —� �� -� <br /> - S�-3 � ,a_, <br /> S¢E OF BLDG FlFE SPNINKLERS REO'D BASEAIENi � <br /> IUI O SF 'I' ._,, YES ,.�p MECHANICAL � i <br /> 22o S�� Gnrt (�/O � ��'� . <br /> OCWFAIJCYLOpD FIREALFFMRE�'� HEIGHTLIMITf.T`ON A�DITIONALPLANCHECK � <br /> A 0 � OTHER 1 . �� i . � <br /> REASON <br /> STATE BUILDING SUPCHARGE i i�'— <br /> WTAKEBY �. PLANS���BV CITY OF EVERETT PUBLIC WORKS �GJ � �"�^ <br /> LOCAL SALES <br /> on,e � TAX CODE IS 3705 TOTAL �7�, I v ,.�, <br /> !� <br />�t1� i . <br />