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APPLICATIC� FQ1; CQNSTRUC��N P�RIIAIT ���� <br /> �1 TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> �y <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC C"1'/�-Y l�inaP I <br /> BUILDING DEPARTMENT <br /> 259-8510 <br /> I I DEMOLITION COMBINATfON �BUILDING tJIECHANICAL PLUMBING SIGN <br /> OWNEPr M4ILAODRESS CITV liP PHONE <br /> G;t.T L�ix�tE,i 37.0o CEc�a ST �Rc� LG�f 982a1 .�.s''�-BBc� <br /> TENANT MAIL A�OFESy CITY ZIP PMONE <br /> S/�M C � �i )NG1L <br /> ARCHITELTORDESIGNER MAILA��RE55 CITY ZIP PHON� <br /> �P��.wcF �cow�. /M Ul �n.v ��t.i cc (.f�A 9Fi(L,9 '�ii .ZB l- �le� <br /> GENEBALCONTRACTOR MAILApDRESS CITV ZIV FHONE S7ATELICENSEK <br /> �C.O G��^E.2AL �nLs'S' '��5 �ioo /`9F...Q.ni<+:� �OG, Co7/•3�j3� 71`'lcOf_T 21-��' I <br /> MECHANICA�CONTRACTOR M�ILFDURE55 CITV ZIP PHONE STATEUCENSEx <br /> ��C�r wA a��Z2C, <br /> PLUMBINGCONTRACT MFILADOPESS CITV ZIA PMONE STATELICENS[V <br /> CLASS OF WOR <br /> �. '�. NEW �ADDITION XALTERATION . REPAIR DEMOLITION �. WOODSTOVFJFRPL INSEP.T �. � BUILDING FELOCATION <br /> . CpNTACT :- /OJy ANGFNONF N(l. <br /> CONTRACT PRICE OF WORM / M /l�CS �S .�'_p✓8 7 L <br /> DESCRIBE WORK AND SOUARE FOOTAGE IHVOLVE� , <br /> P^POmFOSEDUSEOFBWL�ING � HEREBY CERTIFY THAT I HAVE HEAG AND EXAMINED THIS <br /> LJITKG ! S�Q/tfc AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG/.�CRIPTION OF PROPERTV(SHOWN BELOW ORATTACH FOURCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNWG THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi BLOCK oF N�T. THE GHl.NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTH(�RITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER;iTATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONCTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> '7 <br /> 1 c�-�-u-�- !Z- `j- � Z. <br /> PR0.IECTADDRESS sic�u� r.��� onie <br /> �l3 21 . <_a <br /> 9 cirveusine=suce�+seuo <br /> PLUM6iNG . MECHANICAL <br /> NO. TYPE OF FIXTURF.OR ITEM FEC• NO. TYPE OF EDUIPMENT FEE <br /> WATER CLOSET(TOILFT) � AIC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; °ORCED AIR SYSTEMS-6.T.U. M EA. <br /> LAVATORY(WASH[3ASIN) i UNIT HEATf RS—B.T.U. M I <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � _ <br /> LFlUNDRY TRAY WATEH HFATFR ' <br /> CLOTHES WASHEH WOODSTOV� i <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> i ❑RINKWG�OUN'fAIN i FIREPLACE INSER"f i <br /> __ T <br /> FLOOR�RAIN � HEAT PU6II' _ <br /> 6ACkFLOW PN�_VENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICc—EAR,ETC.) I <br /> T <br /> I � <br /> 1 <br /> � SUB TOTAL $ ; SUB TOTAL S — <br /> PERMIT S PERMIT S <br /> TOTAL FEt S ' ?OTAL FEE .�i <br /> FOR OFFICE U5E GNLY: <br /> FPONiSE�BACN NEAPSEiBACN SIOESETBACK PLANCHECKNUM6ER FEE RECFIPTNO <br /> � �� / <br /> USEZOI:E LOTAREA �ACANTSITE FEES VALUATION FEE <br /> BWLDING (0� - Z o� �� � �J <br /> TYPEOFG'JNi°..AILOWA9LE i1PFOFCONSi.FGif!pl oCCUPnxw nnamnui�NGuxnS — �rL_ <br /> �J �N �A ' /]i PLUMBING i <br /> X� <br /> SREOFPLUG NO.OFSTORIES B SEMElT MECHANICAL ' <br /> �3�21fo �fu�� /�D <br /> 3�,�i- /117.7�7�1 ? �.A /l� <br /> OCGOPANCYIOAD FIRESPFNKLEHSREO'0 HEIGHTLIMITFTIGN ADGITIONALPLANCN[CK _� ri /U Y �� <br /> u��-r u <br /> ��J � � SPRINKIER <br /> i <br /> Ri:ASON FOF SPFR,KLEPS --� <br /> �,��,�({(�,�•�, wY{p-7� 4��J4�j%L�j�� �/}{�jZd� (Fy J�("�/ . S7ATEBUIIDINGSURCHARGE __ i <br /> i'�:'H BY 'LANSAFPROVEOHv CITY OF EVERETT PUBLIC WORKS i <br /> LOCAL SALES --� <br /> � �� �� J TAR COD[IS 3105 TOTAL ���jr ; ��� <br /> , <br />