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APPLICATIC��Y FOR CONSTRUC7^JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT hEATING SYSTEM: GAS ❑ ELFCTRIC ] <br /> 259-8810 <br /> � DEiNOLITION i 1 COMBINATION I BUILDING !�MECHANICAL PLUMBING ' SIGN <br /> OWNER l MFILAOORE55 CITV ZIP PIIONE <br /> Lfa 5���,.� ''Z 33cq l�lor�o.� �✓ric �}' 98.'�� 1 .'�S.l -6J"�� <br /> TENANi MAILAOORESS CITV ZIP PNONE <br /> ARCNITECTOR�ESIGNER M4ILADORESS CITV ZiP PHONE <br /> GENERA:CONiF�CTOR MAII ADDRE55 CITV 21P PNONE STATE LICENSE v <br /> MEGNANL^FLCONTRACTOR MAILADDRESS CITY ZIP PHONE STATEUCENSER <br /> �vpr�rttn 5}.,�e ;�� P 0 6�,� l3�9 t���+'�' 9fi�a6 RSJt •311N FvF465-s1 xiY,�7 <br /> PLUM ING CONTRACTOR MFIL ADORESS CITV ZIP PHONE STATE UGENSE 1 <br /> CONTFACT FPICEOF WORK <br /> _R S�b.5 Q <br /> DESCRIBE WOPK AND SOUARE FOOTAGE INVOLVEO CONTACT PERSON AND PHONE 0. <br /> v PrP�%'c Jr, ,2 SZ ^311N <br /> � �7 <br /> Nfl�Abl �n <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PFOPOSEDUSE]F BUI ING I / ApPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��J i c1 Pnc ¢ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALUESCRIPTIONOFPROPEPTY�SIIOWNBELOWOR�TTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT BLOGN aF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�IANCE OF CONSTRUCTION.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 /> . vnace�Tnz i o.r+uMeea CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSiFUCTION LOAN LENDEfl,ADURESS.TELEPMONE NIIMBER <br /> �,(.�-�,., lo-13-9� <br /> PROJEGT ADDRESS =���+��u wr¢ <br /> � 330q er�b.. ci..n�s�vessi�;,�nsr�o - <br /> PLUMBING MECHANICAL <br /> � N0. TYPE OF FIKTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. � <br /> BATHTUB ; / FORCED AIR SYSTEMS—B.T.U.Irx Q� <br /> LAVATORY(WASH BASIN) UNIT HEATERS--B.T.U. M <br /> SHOWER CLOTHES DRYcRS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DfiAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS 2 GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> — � <br /> ; � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT S PERMIT 5 <br /> TOTAL FEE S TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> PRONiSETBACK REMSETBACK SIDESEfBACN PLANCHECKNUMBER FEE FECEIPTNO. <br /> usezor+e LOTAR[A vaenNrsire FEES VALUATION FEE <br /> Il: YES � NO BUILDING � <br /> iYPEOFCONSi NO.OFSTORIES acura4tv Nao�mvnUNCUNits i <br /> r,nour pI11M0WG � <br /> 512E OF BLDG. FIRE SPRINKLERS REO'D BASEMENi MECHANICAL � <br /> �,:i YES �. . NO - <br /> OCCUPANCYL04D FIRE�LARMREOD HEIGNTLIMITATION ADDITIONALPLANCHECK i <br /> i <br /> O7HER � <br /> liE�50N � <br /> STATE OUILDING SUFCHAFiGE <br /> i <br /> INiAKE BV PLANSnPPROVE00Y CITY OF EVERETT PUBLIC WORKS i <br /> LOCAL SALES —T <br /> onre TAX CODE IS 3105 TO7AL <br />