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�loa7 <br /> APPLICATI� FOR CONSTRUCT"�N f€RMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HFATINC;$Y$TFM. f_I(;p$ L�ELECTRIC b J?T �T I <br /> BUILDINGDEPARTMENT L� � � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION I i BUILDING 'j(j MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OW/N}E�RY-� /� n/MAILApOFESS CITY ➢P PHONE <br /> (, / I✓j � C ���/ (- � � i/7A �E �f C� <br /> TENANT IAAILAO�RE55 CITV ZIP PHONE <br /> �< < ��� , {'l� ,��- <br /> ARCHITECi0R0ESIGNER MAILAO�FESS CITV ZI� �HONE <br /> GENERALGONTRnLTOR / NAILAODRESS GITY ZIP PHONE STRELICENSEa <br /> �l'(.' rd�l��% <br /> MFCH4NICALCONTRFCTOF MAILAODRESS CITY ZIP PNOt1E STRTELIGENSEe � <br /> �� <br /> �'fs ,%l��n�is' �o ��r�gi�/ a��cNY'�� s�''z�2 �i /- ��'CG �s��E'x/����� <br /> PLUMBINGCONTRACTOR MnILAD�flE55 CITV 21P PHONE S7ATELICENSEa <br /> CONTqqCT GRICE OF WORH <br /> rz.s�o <br /> OGSGRIBE WORK AN�SOl14RE FfX1TAGE INVMVED GONT�CT PEBSON AN�PPONE N0. <br /> — �taJ �' jG�- r.�C' <br /> ��t�N�' `p �+T�C: Z7.S�' �''' C'lhi�o,V>" �C'Q"�i� �i <br /> IJt tr,.( <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIOfJS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> iecn�oescaiamNCFraoPearv�sHowNee�o�voannacN.wocovies� WORK WILL 13E COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GfiANTING OF A F'tRMIT DOFS NO'f PRESUM'. TO GIVE <br /> �or e�ceK - oF — AUTHORITV TO VICLATE QS CANCEL THE PROVISIOf�S OF ANY <br /> OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPE TY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MA AND I COMPLY WITH THE STAT[ <br /> PARCEI TA%I.D.NUMBER CONT 5 LAW 1 . 7 FiCW AND 296.200 WAC. <br /> GONSIRUCTION LOPN IENDER.AO�PESS.TELEPHONE NUMBER � n • ��r �j. ` <br /> l� 1 � ��k p (' l�a D(c�„� ar' ' 9, /� / � <br /> PROJECTAQDRESS s�cunr �e — o�re <br /> crtr ousx�ess ucervse r+a <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATE'9 CLOSET(TOILET) i A!C—A/HNDLG UNITS—H.R _ <br /> BATHTUB ' FORCED AIF SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � _ <br /> SHOWER CLOTFIES DRYERS ' . <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> DISHWASHER FlANGE HGOD _ <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUPNING) � <br /> DRINKING FOUNTAIN FIR`cPLACE INSERT _�_ <br /> FLOOR DRAIN � tIEAT F'UMP _ ' <br /> BACK�LOW PREVENTERS ; GAS PIPING __ � <br /> ROOF URAINS—RAINLEADERS � EXHAUST FAN <br /> 5!NK(SfRVICE—BAF,ETC.) <br /> �T <br /> I <br /> 1 �- <br /> SUB TOTAL 5 SUB TOTAL 5 _ � ; — <br /> PEFMIT S PERMIT S _�� <br /> TOTAL FEE $ TOTAL FEE 5 � / <br /> FOR OFFICE USE ONLY: <br /> FRONTSE79ACN REARSET��CK SIOESET�ACK PLANCHECNNUlABEH FEk! PELEIPTNp. <br /> uSezoNe LOTAREA VACANTSITE � FEES VALUATION FEE <br /> ❑ YES �- NO BUILDING ' <br /> 7YPEOFWNSi. NOAFSTOFIES aRuva4tr r�oa�a'sr.i.rr;u�du � <br /> �A°tl° PLUMBING <br /> SIZE OF 9LDG. FIRE SPPINKLERS REO'D BASEMENT MECHANICAL Z I✓� <br /> G YES i.-1 NO <br /> ADDITIONAL PLAN CHECK � <br /> OCGUPAACYLOAD FIREALARMREOD HEI.iHTLIMITATION - <br /> i <br /> JTHER <br /> T <br /> REASO�� <br /> STATE BUILDING SUFCHAR�E <br /> INTANE BV PLPHSF"PHOVEO DY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br />