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APPLICATIC 1 FOR CONSTRUCT' 1N PERMlT � <br /> � i TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � HEATING SYSTEM' �J GAS U ELECTRIC tl I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> r_ DEMOLITION ' COMBINATION ! BUILDIN: f i MECHANICAL -;PLUMBIHG -: SIGN <br /> p1YNER IdPILADDRE55 GITY ZIP PH04E <br /> ,�i�,� s�c/�r�/ 23w,eo��rorv�r <«rrrt Z9�'l 99 33 g- �yy� <br /> TENANT IA4ILADDRESS ��N <br /> ARCMITECT OF DESIGNER MAIL AODRESS <br /> Clh 21P PMONE <br /> GENEFALCONTRACTOR NAILPDDFE55 `ITY 2iP PHOIIE STATEUCENSE• <br /> �ar..�c ��/.{'E��/I.�xJF `f'�/OZ /B'`�Af�".1/6' �YI/�/si//ll,� fB2�o 3�i/-OGy; �EIF/Ro96Tj� <br /> IdEGHANIGALCONiRAGTOR MPILADDRESS <br /> CITV ZiP PHONE STATELIC NSE <br /> PLU�•�B:YGCONTRPCTOF MAtlA0DRE5S <br /> CIiY Z�P PHONE ST4TE LIGENSE� <br /> CONTPACT PFIGE OF 1YORK <br /> DESCRiBE WOFH ANp SGUARE FOOiAGE INVOLVED <br /> L04TACT P: J 'D PH NE NO.� 33 - ��� <br /> l'c.E/Z�"J� ZS/>l0 ..f6�. FT. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USEOf BUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVF.RNItJG THIS NPE OF <br /> LEGALOESCRIPTIONOFPROPERTV�SHOWNBELOK'OF/.T7ACIITYJCCOPIE51 N�R THELGRAkT01NG OF AD ERMITJDOES NOTPRIESUME TO GNE <br /> �pr BLOCN oF pUTHORITY TO VIOLATE OR CANCEL 7HE PROVISIOIJS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEflTV TO PERFORM THE WORK FCii WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH T�1E STATE <br /> ^ARCELTA%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUGTION IOAN LENDER,AODFE55.TELEPHONE NUMBER , „ . � �j�� � /�Z <br /> .l!% /C / � L� � <br /> $C <*WiY <br /> PROJECTADORESS Z circnus��r+cssiiceriserio <br /> � � J '� �� MECHANICAL <br /> PLUMBING TYPE OF EOt�IPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. <br /> WATER CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> FORCED AIR SYSTEMS—b.T.U. M E.A. <br /> BATHTUB �i UNIT HEATERS—B.T.U. M ��_— <br /> LAVATORY�WASH BASW) — , — CLOTHES DRYERS � <br /> SHOWER . VENTILATION FAN <br /> KITCHEN SINK&DISP — --�— <br /> RANGE�i00D <br /> DISHWASHER <br /> LAUNDRY TRAY 1M1'ATER HtATER <br /> WOOD STOVE <br /> CLOTHES WASHER __ — METAL FIREPLACE(WOOD BURNING) <br /> UNINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN HEAi PUMP <br /> FLOOR DRAIN � GAS PIPING <br /> BACKFLOK'PREVENTERS ' � <br /> ROOF DRAINS—RAINLEADERS � EXHAU�T FAN <br /> i <br /> SINK(SERVICE—BAR,ETC.) i <br /> — � <br /> � �—�— <br /> SUBTOTAL S <br /> SUB TOTAL 5 pERMIT S <br /> PERMIT $ TOTAL FEE 5 <br /> — TOTALFEE 3 <br /> FOR OFFICE USE ONLY: aeceiar r+o. <br /> FRONTSCTBACH FEARSETBAGK SIDESETBAGK <br /> PLANGMECHNUMBER FEE <br /> LOT AREF VACANT SITE <br /> FEES l'ALUATION FEE <br /> uSCZON[ ;1 YES C7 NO BUILDING � �� � - <br /> i <br /> TYPEOFLJNSi. NOAFSTORIES octuvesn •:ooruxtwti'.�itiit5 <br /> c4ouv pLUMBING <br /> i <br /> SREOfBLW. FIRESPRINKLERSREO'D BASEMENT MECHANICAL __ � — <br /> i� VES ❑ N� — ; <br /> HEiGMT UMITnT10N AODITIONAL PLAN CHECK <br /> OGCUPr1NGV LORD FiRE ALPRM REOD � <br /> OTHER __ � <br /> REASON , <br /> STATE BUILDING SURCHARGE � <br /> i <br /> iNiAKEBY PUNSAPPROVEDB� CITY OF EVERETT PUBLIC WORKS ,� <br /> LOCAL SALES � ; j l <br /> onre <br /> TAX CODE IS 3105 T�'"= <br />