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A,PPLICATlC�] FC�R CONSTRUCT'7N PERMIT ��'�" <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> /�'/3797Cc _.� <br /> BUILDING DEPARTMENT HEATING SYSTEM: ,_I GAS J ELECTRIC ❑ <br /> ?.59-8810 <br /> DEMOLITION COMBINATION BUILDING xMECHANICAL PLUMBING SIGN <br /> OWNER MFILADDPESS CITV LP PHONE <br /> �r or- cv�e� 3zoa C�.-�.Q � c-��2E-rr w� 9s2p 1 IZoG) zs`�-��e <br /> TENANT �d/�LN�DRE�S CI7V ZIP PHONE <br /> CITY OF l='Vc.RGTf L�133 LL1L'C ChF�77LAt.•� �v �v.�r.> WA �j$Z9`{' LZ�Cn�2S`J- ��� <br /> ARCHITEGTORDESIGNEF M�ILADDRE55 CitY ZIP PHONE �'ZQ(;� <br /> R2�aN ,v+)n �'v�xw�u.. �ou vJrasr {Jta�2e,soN sT �'�,�zE w.�a 9�//9 ��„`�� <br /> GENEdFLCONTRACTCR MAILApDPE55 CIIY 21P PNONE STATELICENSEa <br /> �M W �.�E.a . CoU_.'� �t��t C-��m 1�'lc=u��� �E�6uAn�+,WA �1�"—'�� _ <br /> MECHANiCALCO�IIAAGjJR h1AILAD�RE55 QTY ZIP PHONE STATELICENSEp <br /> C Z �zo�� c��i -393co rN�wc—rz,s�i <br /> O UMBINGCONTRALTOR MAIIADDRE55 CITY 21P PMONE STATELICENSEc <br /> CLA55 OF WOFK <br /> -. . NEW x ADDITION . ALTERATION ' REPAI DEMOI,ITION WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> ,1 ''} ty CONtACT'EFSOP;AND�HONE NO. �J <br /> CONTRAGTPRICEOFSVORN � /(Jf (J�� ��I/� ' � _ / �/�� �v�' ?�'. T--`�` �— ���" <br /> �ESCRIBE WOfiK FND SOUFFE F.'XITAGE IN90Lf D � <br /> /G�'-= f�=�w�;[" L�iaL 7S"' SF : iT <br /> PROPOSEDUSEOFBUIL,pinc_ � � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> OF F1Ct?. n-.�.c-C� C'�SOy �� --' APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRIPTIONOFPROPERTY�SROV/N�ELOWORATTACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCH oF NOT. THE GRANTING OF A PER�dIT DOES NOT PRESUME TO aIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTRUCTICN.THAT I AM AUTHORIZED BY 7HE <br /> UWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATF <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> (,v133 LAY.E C#�lhP�-L� x��.�--� r1 !C�-�- /2////q2 <br /> PROJEGip00HE5S sic�u„u[���._� �ALE — <br /> 1 �1 L� <br /> � ^���"�I yV�, CIIVPO5WE55LIf.ENS[ND <br /> PLUMBING MECHANICAL � <br /> NO. TVPE OF FU:TURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A�HNULG UNITS—H.P. <br /> BATHTUB FORCED AIR�VSTEMS—B.T.U. M E.A. <br /> LAVATORV('AIASH BASIN) i UNIT F:eATERS—B.T.U. M i <br /> �— <br /> SHOWER CLOTHESDRVERS _ <br /> KITCHEN SIIJK&CISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAY ; WATER HEATER __ <br /> CLOTHES WASHEl3 � �NOOD STOVE <br /> URI�AL ' MC-TAL FIREPLACE 8 CHIMNEY ' <br /> i <br /> DRIRKING FOUNTl�IN FIREPLACE INSERT _�_ <br /> FIOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVL'NTERS - GAS PIPING i <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN _�_ <br /> � <br /> SINK(SERVICE—BAR, ETC.) — <br /> � <br /> SUB TOTAL $ SUB TOTAL $ <br /> PEFMIT S PERMIT S <br /> TOTALFEE S TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN FEARSETBACK SIDESEiOACK PL�NCHECK�l1MBER� FEE RECEIPTNO. <br /> � <br /> usezoNE LOTAREA VACANTSITE FEES VALUATIOiJ FEE <br /> BUILDING � ' <br /> iYPEOFC(INiSALLOWABIE lYPEOiGON51.PCTUAL a2�'vFnLv NO��bvFLLiNowu6 � <br /> c�wv pWMBiNG <br /> SIZE OF BLC,. NO.OF STOFIES �ASEMENT MECHANICAL � <br /> OCCUPANCVLOAU I FIRESPRNNLERSREO'D HEIGHTLILIITAiION ADDITiONALPLANCHECK i — <br /> SPRINKLER � <br /> REASON FOR SPRI�IKLERS <br /> STATE BUILDING SURCHARGE <br /> INTAKEBV I PLANSFPPRWeDBY CITY OF EVERETT PUBLIC WORK$ i <br /> � LOCAL SALES <br /> I TAX CODE IS 3105 TOTAL ; <br />