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.-� <br /> APPLICATIQ , FOR CONSTRUCT'-`N PE�MIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIri' <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELEC7RiC ❑ <br /> 259-8810 <br /> ❑ DEMOLIiION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING �SIGN <br /> OWNER MAILADDRESS GTV ZIP °NONE <br /> �L W6t0/n/4 $IIPPLY/N�� �X S/SS �/.30/ ?y0711 SH� ��/N,VlkyLd�WiG. 9P03G �7P'2/GG _ <br /> TENANT WILAD011E55 Cltt 21P P110NE <br /> ARCHITEGiORDE5IGNER M�IL�DDRE55 LITY ZIP PNONE <br /> GENEHALCONiR�CTOR M�ILADDRESS CIN ZIP PHONE Si�TELIGEN9E� <br /> s�,�u� s✓��✓ �Ne /7o3� ,vri�o� A� N s��rnE w.o y�•33 s�2-p�� <br /> MECNANIGLLCONTAACTOR M�ILADDRESS CIiV ZIP PHONE ST�TELICENSE� <br /> S�/v�eEs�ii dT� <br /> PLUMBINGCONTR�CTOfl M�ILADDRESS GITV ZIP PHONE STRTELICENSE� <br /> ' CONTRACT PRICE OF WONK �-p . <br /> ?F�a. <br /> DESCPIBENtlRKI.��REFOOT�J�OLVED /�� 0�� S�N(sGEFA� CONT�CTPERSONANDPHONENO. �//wy d�^,��a/�s <br /> � /7 C� /c.fcAf FY <br /> i <br /> ' �cT,U�w.or,c SuN .SNa�eun� Si�N inR'• S�f2-o93 _ . <br /> i I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOFBUILOMO APPLICATION AND KNOW THE SAME TO BE fRUE AND CORRECT.ALL <br /> � �{�/�J(,� SUPPUES PROVISIONS OF LAWS AND ORDINANCES GOVERNING TMIS TYPE OF <br /> LE(i4LpEyGpIPTqNOFMqPERiV(SHOWNBEIOWORATTACMTVOCAPIES) WORK WILL BE COMPLETED WITH WHFTiiER SPECIFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �� iot e�ocrc oF AUTHORITY TO VIOLATE OR CAN�:EL THE PHOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUiATINCi CONSTHUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br /> �, - OVYNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � P�RCELTA%I.D.NUMBEN APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> � CONTRACTORS UW 7827 RCW AND 296.200 WAC. <br /> ICpNSTpUCT10NLOMILENDER.l1DDRESS.TELEPNONENUMBER � <br /> ! ��11.�.�..� ��-�,.,,.� �- 7- 9s <br /> PRQIECTADDRESS �jS3G H�wizr ,o�� SqNATUqE �2 �� <br /> /� cmeusnhss ikEnse ra <br /> �, p���Np MECNAIMCAL <br /> �. ►q, TrPE OF FlXTURE OR ITE� FEE NO. TYPE OF E.]UIPMENT FEE <br /> �. WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS--H.P. � <br /> g�n{7�g ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � � VENTIUTION FAN ; <br /> � DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> . CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DHINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> �SINK(SERVICE—BAR,ETC.) ; � <br /> _ , <br /> � <br /> � , <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT $ <br /> TOTALFEE $ ' TOTALFEE $ � <br /> FOR OFFlCE USE ONLY: <br /> FRONTSE78ACR REAP SETB�CK SIDE SE7BACK FLAN CHECK N BER FEE RECEIPT NO. <br /> •- a� aS 35� � v <br /> ' USEZONE �AjE�/�q�� 1 VACANTSITE FEES VALUA710N FEE <br /> G•-' y�{/ Y ❑ YFS �NO BUILDING ' <br /> TYPEOFCONSI. N�.OFSTOflIES a[�uwxcv xoarowtti�xGuxits � <br /> caW' PLUM8ING i <br /> SIZEOFBIDG. FIRESPRINNLERSREO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANGVLO\D FIREALARMREO'0 NEIGHTLIMITRTION ADDITIONALPLANCHECK i <br /> ��� OTHER ' <br /> REASON ' <br /> StATE BUILDING SURCHARGE � N ; <br /> INTAKE BY PLAN PPROVED BY CITY OF EVERETT PUBLIC WORKS � <br /> /jr� LOCAL SALES <br /> o '_�j_gs TAX CODE IS 3105 T�TAL �j � <br />