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5 <br /> A <br /> APPLICATIQ"� FOR CONSTRUCT'�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ELECTRIC 0 v�b wr� � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION f�UILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfl � MAILp00RES5 CITY ZIP PHONE <br /> �'lA��es�\la�a.k:+� �,�°( �e�LLvrrc k'� ���\` �i�'.�c.�i '�S`b `�3 6 � <br /> TENANT MAILAD�PE55 CITV ZIP PHONE <br /> ARCHITECTORDESIGNER MAILA�DRESg CITY ZIP PHONE <br /> C� a���,E,�...� yi•�; � =� h��e. F1�t� �52- �6��fr � <br /> GENE CONTRRCT �� � MAILADqqE55 CITV ZIP PHONE STATELICENSEA'� <br /> � L� �e%ct�L. -��X s�e�s �o.� /o�� �%'of` S�7'L�`� 9�a.�3 <br /> MECHANICALCONTRACTOR MAILAODRE55 GIN ZIP PHONE STATELICENSE� <br /> 1��2 3 Ca.sa - 9vi� i,�EsS ff�. ��/��o <br /> PLUMBING WNTRACTOR MAIL ADOqESS CITY IIP PHONE STATE LILENSE x <br /> CONTRACT PqICE OF WORK �y 97� <br /> E� (�t2�X �\y,�bc� / <br /> DESCRIBE ORKANDSOUAREFOOTAGEINVOWEO CONT CTPERSONANDPMONENO. <br /> � .. w -l�.x c��cz a �..,R:.�� a_�=,�_<�� <br /> �- <br /> R_ �rr� �� =��,n ^ � - :� � n � � r' -a• <br /> '3�� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED OSE OF 9WLOING APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECL ALL <br /> ��J� PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TYPE OP <br /> LEGAL�ESCRIPTIONOFPpOPEh�V�SHOWNBELOWORATfRCH1WOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior-��- eiocH--L- oF U��'� ,t<��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � 1 ` AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> QcDVt��c9J�.•-1-n Z-�.3cRG�,\ l�\ . q� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> "_ '�c,"' 1, PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � '{^!s��� �Jc� � C A C�' �U��-. OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%I.tNUK'cR T—� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTFiACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLORNLENOER,ADDRE:S.TELEPMONENUMBEF <br /> �� � <br /> PRO CTADD S sicN�t e A� �}u�� � ^,\_� <br /> o.re <br /> ZLRYbII NESSLILENS[NO <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE GR REM FEE N0. TYPE OF EQUIPMENT FEE <br /> O WATER CLOSET(TOILE7) � p A/C-A/HNDLG UNITS-H.P. , <br /> b BATHTUB ; L`� FORCED Alfi SYSTEMS-B.T.U. 41 E.A. <br /> o LAVATORY(WASH BASIN) � O UNIT HEATERS-B.T.U. M ' <br /> O SHOWER � � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � ; O VENTILATION FAN � <br /> DISHWASHER � � RANGE HOOD � <br /> ,� LAUNDRY TRAY ' p WqTER HEATER � <br /> n CLOTHES WASHER � � WOOD STOVE ; <br /> � URINAL ; J METAL FIREPLACE(WOOD BURNING) <br /> q� DRINKING FOUNTAIN � D FIREPLACE INSERT ' <br /> p FLOOR DRAIN � o HEAT PUMP � <br /> BACKFLOW PREVENTERS � O GAS PIPING � <br /> G ROOF DRAINS-RAINLEADERS CJ EXHAUST FAN <br /> EJ �SWK(SERVICE-BAR,ETC.) ; <br /> � <br /> � <br /> � , <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT $ ; <br /> TOTAL FEE $ ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAC; REARSETBACK SIOESETBACK�'�Nt• Siv P�NCNECKNOMBER iEE /i PEC TNO. <br /> 51ioWni ' er s / ? �Q5 `�� OZ�' <br /> 11SEZONE LOTAREA VACANTSITE / FEES VALUATION FEE <br /> ' ❑ VES IL�NO BUILDING �[pa 'On <br /> iYPEOFCONST. NO.OFSTORIES octuvancr NJofmvEu'NcuNrtS <br /> ceow I PLUMBING � <br /> i <br /> � _ � <br /> SRE Of BLDG. FIRE SPRINKLEPS PEO'� BASEMENT MECHANICAL i <br /> !13 S � ❑ YES ❑ NO <br /> OCGUPANCY LOAD FIPE ALARM REO'D MEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> 1 - <br /> � OTHER � <br /> REASON — <br /> STATE BUIL�ING SURCHARGE ; �J <br /> INTANEBY PLANSAPPRO�BV CITY OF EVERE!T PUBLIC WORKS � �O�� <br /> LOCAL SALES <br /> DATE 7 �y � TAX CODE IS 3105 rorn� �S U <br />