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APPLICATIC 1 FOR CONSTRUCT'�N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> 259-8810 � <br /> ❑ DEMOLITION C 1 COMBINA710N I1?'BUILDING �l MECHANICAL ❑PLUMBING SIGN <br /> OWNER MRILADDRE55 � GTY 2IP PMONE <br /> �oVt�aSGE%C�Fw�c. M�lJ� GCMfi�IZ po �c lob7 E�T q����O 25b -'liz'3 <br /> TENANT MRIL ADDRE n dTV ZIP PHOhE <br /> h�wt6 ��'!� �.i�i'J'p ( /vr� _ <br /> ARLH�R DEcIG�� M/IL A�� �� ������ � � PHON2yi 9-o6r�6 <br /> H � <br /> GENERAL CONTRAGTO�i MML�DDRESS CITV ZIP PMONE STATti UFENSE k <br /> �w�v1 �a�ahrnvc.ncRt Pa r�ox �15n ra,r�r_w� yfao� ��u+.�c�rs,y�o <br /> MEGH�NICALCONTpACTOR MAiLqDDRE55 GiY ZIP PNONE SIATFUCB�S[� <br /> PLUMBINGCO^�TRACTOR M4I�pDDRE55 diY IIP PHONE SUTEUCENSEM <br /> CONTFACT PRICE OF WORK I /^ O� eU <br /> !1 � — <br /> OE�CRIBE WOR;ANb 5 UAqE F00�����ED � �vl�� WNTACT PERSON AYD PNONE N0. �� - — <br /> -�K v I�l� �� <br /> �1,'cC�W GkAK.�r2 'R� _ <br /> IIIIY �I 1W4.1 1\� v l I HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPO$EDUSEOFBUILDING /�p 1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRC-GT. ALL <br /> �-Ir ItR PROV!SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �e�aioescairtiorvoFVRorearrisHormee�owoan*tncNtwoeoaiesi - WORK WILL BE GOMPLETED WITH WHETHER SPECIFIED HEREIN OR - <br /> NOT. THE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> �or BLOCN oc AUTHORITY TO VIOLATE OR ChNCEL TH[ PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE <br /> — --- PESFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE� �Y THE <br /> OWNER OF THIS PROPERTY TO PC-RFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STAT[ <br /> P�RC2L tA%LD.NUMBER CONTRACTO 18.27 RC W AND 296200 WAC. <br /> CpNS;RUCTION LG4N�kNDER,RU�NiSS T�MONE NUMBEF _ w���—^ - - <br /> �A r_ ni��.r u �.1Q.. <br /> ,7�10 Y�4/�rLL �� �l <br /> PROJECT ADDRESS s�cNn* � on�c � <br /> ��.. �z �_�„�:F�sF,� <br /> �z-- <br /> PLUMSIN(i MECHAMCAL � <br /> N0. TYPE Of FIXTURE OR ITEM FEE NO. TYPE OF EQ�IP�NENT FEE <br /> W'ATER CLOSET(TOILET) AiC—AIHIJDLG UNITS—H.P. <br /> BATHTUB PORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATEHS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 8 D�SP ; VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOODSTOVE _ <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> — —'T— <br /> FLOOR�RAIN HEAT PUMP _ � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXIiAUST FAN <br /> SINK(SERVICE—BAR.ETC.4 ; <br /> � <br /> -- <br /> T—_ <br /> SUB TOTAI S SUB TOTAL $ <br /> PERMIT $ PERMIT $ _ <br /> TQTALFEE S TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> ;RONT SETBACN f1EAR SETBACK $IDE SETBAGN PLAN CH'Es N NUMBER FE[ FECP,Pi NO //� <br /> �IJ�..� � , .3 /�JcG�� <br /> usemee LOTARSR vncnNTsiTe FEES VALUATION FEE <br /> i; YES —. NO I Z G��� ��S(�Y_✓__U <br /> - � BUILDING <br /> TVPE Of GON57. NO Of StOfiiES occuveucr im u�wiAurcum•ts <br /> Z FIZ I �I. Z6��r .� PLUMBING <br /> SIZ[OfOLDG FIRESPRINKLUERSFWD BASEMENT MECHANICAL � <br /> � G .";�. 7�:j '� YES �NO -- — � <br /> O�C,vC�UPANGY LOAD FI(iE nLABM�,yR�EOD NEIGHT UMITATION AL�PITIf)NAL PLAN CHECK i <br /> ur �1 /FL•N OTNER —...— --y ' <br /> FEASON �/T-'^ <br /> G/rGJ Ga,'�1��yitA S7ATE BUILDING SUPCHAFGE _�_�[/ <br /> .�7� f !Gf r� <br /> W iANE BY PLANS FPPROVED BV CITY OF EVERETT PUBLIC WORNS 'y <br /> ��M LOCAL SALES <br /> onre �2�i TAX CODE IS 3105 ror�� 7��� � _ <br />