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� ��� <br /> 3'S APPLICATIC�! FOR CONSTRUCT�N PERMIT - <br /> TO BE COMPLETED IN BLACN. INK—pLEASE PRINT �� <br /> BUILDING DEPARTMENT �HEATING SYS i EM: v GAS .�ELECTRIC ] <br /> 259-8910 <br /> ' DEMOUTION COMBINATION BUILDING ( ': MECHANICAL �'PLUMBING <br /> OWNEfl IdAIIADDF[55 � ���� -� S�GN <br /> 21P PHO�1L <br /> DAu.y /{omES, rac. 3Yao E,tsnnr.�. Me E. ��a $��� 98���— <br /> 1ENANT IpAILADDRESS `j�$'3,7G <br /> CItY ZiP PHONE <br /> ARCHRECTOFO:SIGNER lJAILqDOFE55 CITV <br /> Z��' PNONE <br /> GENERALCONiPACTCR AIAILAO�RESS GiY <br /> ��P PHONE STATE LICENSE p <br /> 1dECHqNICA!CONiRqCTOF MAILAO�IiESS CITV <br /> n N � ZIP PHONE SiATE U[ENiE a <br /> r <br /> �'WIdBINGCONTRACTOR h1FILADORESS CITY <br /> Z�P PHONE STFTELICENSEu <br /> Pa�A��a�t r,�c Po R�x sca�zy K�.�.,onc 9gos.R �lss•ase PACSFAP�bYCM <br /> CONiRFCi PFICE OF WOflH — <br /> DESCRIBE WORK AND SOUARE POUiAGE INVOLVED <br /> CONTACT PERSON AND PHONE AO. — <br /> PROPOSEOUSEOPBUILDING I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUc AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOV[RNING THIS TYPG OF <br /> iecn�o=5cairnoNOFppoaearv�sHowNee�owonnne.cu7wocoPies� WORK WILL BE COMPLETEu WITH WHETHER SPECIFI[C HEREIN OR <br /> ��T— o�ocK pF , NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GNE <br /> AUTHORITY TO VIOLATE OR CANCEL TH� PROVISIONS OF ANY <br /> OTHER STATE OR �OCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED DY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anace�Taxi�.nurnoen APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTqqCTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADORE55,TELFpHONE NUM�EF <br /> PROJECTADDRESS sir+n mc ��- � �15�9�/ <br /> 3S 3/ n a T'J7 onic <br /> KR�Mc�L. AJE EJEktTrT LoY: RH•S cu.evs�+cssuccrvsu:� ' <br /> PLUMBING MECfiANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMFNT <br /> _� WATER CLOSET(TOILET) FEE <br /> AiC—A,HNDLG UNITS—H.P. <br /> �, BATHTUB � ' FORCED AIR SYSTEMS-9.T.U. M E A <br /> LAVATORY(WASH BASIN) I UNIT HEATEFS—B.T.U. M <br /> / SHOWER CLOTHESDRVERS —T— <br /> _L KITCHEN SINK&DISP ' <br /> / DISHWASHER ��ENTILATION FAN i <br /> RANGEHOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STUVE — <br /> URINAL METAL FIREPLACE(WOOD BURNING) —r— <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOF DRAIN HEAT PUMP � <br /> _�— <br /> _ BACKFIOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) i <br /> � SUB TOTAL S _ ��TQQ SUB TOTAL ^� � <br /> _ PERMIT 3 _ � ,oa PERMIT $ <br /> TOTAL FEE $ .� TOTAL FEE <br /> 5 <br /> FOR OFFICE USE ONLY: <br /> Fi90ryTSEiB4CK F[ARSETBFCK SIpESETBACK PLANCHECKlU E FE[ <br /> �� RWEIPI NO <br /> �_�� � <br /> USEZONE LOTAR[M1 VAChNTSIiE FEES <br /> . �. YES .-_ NO VALUATION FEE <br /> �rr�orcoxst NaoFsroAies BUaoiNc <br /> ocmw,cv uooror,eurc,am:ns <br /> L^.OJP — <br /> a�uMoiNu <br /> SiZf OF BL�G FIRE SP{�INKLEFS REO'0 BASEMENi <br /> '-' YES .� NO MECHANICAL <br /> OCCUPANCYLOAO FIREALAqMqEOD HEIGHiLRJIiFT10N ADDITIONALPLANCHECK <br /> n[nsON OTHER <br /> STATE BUILDING SURCHAqGE <br /> INL�c�[Pt------ PL�NSAPPRpyE�gp <br /> CITY OF EVERETT PiJBLIC WORKS <br /> LOCALSALES ' <br /> o^TE TAX COUE IS 3105 rora� , <br />