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AI�PLICATIQ ! FOR CONIST�UCT" �N PE�iMIT � <br /> TO BE COMPLETED IN BLACK INK—"; EASE PRINT <br /> HEATING SYSTEM: J GAS �.J ELECTRIC .J �1 �'� � <br /> BUILDING DEPARTMENT <br /> 259-8610 Cl,' �� � : <br /> DEMOLITION I COMBINATION I BUILDING I i MECHAh'ICAL !xPCUMBING ;r �L I SIGN <br /> OIVNER tAAIL�DOPE55 CIiV ZIP PHC4E � �_ ll.. <br /> y-�)t. <br /> 4Rc.(.`� /�oMES 3YJ.o Ensr[n� �!✓E E. '�aoo SFRrrcE 9S/4a. 3a.s-37b <br /> IENANT fdAILA0DPE55 CITY ZIP PHONE <br /> ARCHITECTOROESIGNER lAAILqODflESS CIIV ZIP PMONE <br /> GENERFLCONTflFCTOR fdAILA0�RL5S LITV 21P PNONE STdTEUCENSEn <br /> IdECHANICALCONTFACTOR MAILAD�iiE55 CITY 21P PHONE STATEL�CENSEa <br /> PLt11dBiNGGONTRACTOfi IdAILADDRESS CRV JP PHGNE STATELICENSEk <br /> P�P r�c. P.o. Box gaa39 �c,�.�zE �✓.s• 9B'aa-s Ysa asxS PacaFaa��s�c.r� <br /> CONiRACT VRICE UF Y/ORN � <br /> DESCRIpE WORK AND SOUAqE FOOTAGE INVOLVED CONTACT PERSON AND PHONE N0. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaoaosEo usE ov euaowc APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP[OF <br /> LEGALDESCRI?TiONOFPPOPERTVISNOWIJdELOWORATfFCNTVlOCOPIES� WORK WILL DE COMPLFTED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ?ERFORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FUR WHICH <br /> anace�Tnxi.o.NUMaea APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> COHSTRUCTIONLOANLENOER,AODRESS,TELEPHONENt1MBER <br /> vP / o/aa/9si <br /> PROJECT ADDRESS sc� unr �''J— nnic <br /> 3 C �/�� �/c. AuE E�a�-r lar: Rrr-v9 �'a� ��,�— -- <br /> p� /JtiM CiiVAJtiiNE$SUCFllS'f10 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> 3 WATER CLOSET(TOILET) y � AiC—A/HNDLG UNITS—H.P. I <br /> 02.. BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) ag � UNIT HEATERS—B.T.U. M i <br /> / SHOWER CLOTHESDRYERS <br /> / KITCHEN SINK 8 DISP � ; VENTILATION FAN ; <br /> % DISH�NASHER 7� RANGE HOOD F <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> �FLOOR DRAIN HEAT PUMP � <br /> — � p,i�:KFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' <br /> � <br /> � <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT S �?D�OD PERMIT S <br /> TOTAL FEE 5 ;p TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FFOtJTSETBACK REARSETBACK SIOESET6ACK PLANCHr_CKNl11ABER fEE RECEIPiNO <br /> c � 1//r' <br /> usezorvE �oiaaen vacnNrsire FEES VALUATION FEE <br /> .�. YES ^� NO BUILDING <br /> ivPE0FC011Si NO.OFSTOflIES cccuvanp rypafowiwScvaR <br /> caouc p�UMBING <br /> SREOFBLDG FIRESPRINNLERSi�E�'� BASEMENT MECHANICAL <br /> `—: YES NO <br /> OCCUPANCVLOAD FIREALAFh1RE0D HEIGMTLIMITATION ADDITIONALPLANCHECK <br /> OTHER <br /> REASON — — �— <br /> STATE BUILDiNG SURCHAflGE � <br /> Cil;.rc[L'v PLANS�PPFOVEDBV CITY OF EVERETT pUBLIC WORKS <br /> LOCAL SpLES <br /> nnre TAX CODE IS 3105 Tora� <br />