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APPLICATIC �l FOR CONSTRUCT" 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—FLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: f+�GAS U ELECTRIC ❑ _ 1 <br /> 259-8;10 <br /> ❑ DEMOUTION i-1 COMBINATION iJ BUILDING i✓MECHANICAL L� pLUMBING ❑ SIGN <br /> OWNEF MAILADDIiESS CI7V 21P PHONE <br /> �!�Dy4 NN� �� /7�C � c, H✓E E� L`� V c RETl �,7ao� �a s- SBa a <br /> tENANT MAilA0CRE55 CIIV ZIP PHONE <br /> ARCHRECTOR�ESIGNER IAAILADDRESS CITY ZIP PHONE � <br /> GENERAL CONTRACTOR MAIL AODRESS CITV ZIP PHONE SiATE LICENSE s <br /> MECMANICALCONTRFCTOR MAILAODRE55 dTV ZIP PHOt7E� STATEUCENSEM <br /> �Oc.v� �.✓-2�y /y�ai -Gyn. A✓cl,J. .�Yi✓Ntvnn_�] 1`8a3� �S'.5 ��8�5 -1Jcfl�ESob/aJ�f1 <br /> PWMBINGWNTRALTOR 1141LqDOPE55 CITY ZIP PMONE STATELICENSEs <br /> GONTRACT PRICE OF\YORK <br /> A'saio,o o � <br /> DESCRIBE WORK AND SOU4RE FOOTAGE INVOLVED CONiACT PERSON ANO PNONE N0. <br /> `7 '83/.> <br /> AS R HOE Norw�7r'�,2 �ToGr� NELSnn/ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINGD THIS <br /> PROPOSEDUSEOFBUIIJING APPLICATION AND KNOW THE SAME i0 BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESGRIPTIONOFPPOPERTV�SHOWNBFLOWORAITRCN7WOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�aK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR Tur- <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS FROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND i COMPLY WITH THE STATE <br /> PARCEL TAX 10.NUMBER CONTRACTORS LAW 18.27 RCW AND 29G.200 WAC. <br /> y8v� -oo�- oi9 — v3oG <br /> CONSTRUGTION LOAN LENDER,ADDRESS.TELEPHONE NUMDER �� <br /> PROJECT ADDRESS ' ���'"` �� ///�/`7`' <br /> sic +� o ic <br /> cnveusivrssuc�vs!r.o ,�77�5� — <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TO�LET) � A�C—AMNDLG UNITS—H.P. I <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HFA'ERS—B.T.U. M � <br /> SHOWER CLOTHESDRYERS <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 DRAIN HEAT PUMP <br /> � DACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � � <br /> _ <br /> --� <br /> � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT S PERMIT $ � � <br /> TOTAL FEE S ; TOTAL FEE 5 �'� <br /> FOR OFFICE USE ONLY: <br /> FRONT SEIBACK REAF SETBACK SIDE SETBACN PLAN LI/ K NUM9 R FEE RECEIPT NJ. <br /> /��>� - <br /> usEzor+e LOTAREA VACANTSIiE FEES VALUATION FEE <br /> � <br /> �� YES '.J NO pWLD11JG <br /> TYPEOFCONST. NO.OFSTORIBS w<uoAN[r NOafGNTIUNGUNirs — <br /> snauv pLUMBING ' <br /> SIZEOFOLDG. FIRESPRINKLERSREO'D BASEMENT IdECHANICAL i + <br /> L YES �:i NO <br /> OCCUPANf,y�pqD FFEALARMREO'D HEIGHTLIMITA?ION ADOITIONAIPLANCHECK � <br /> � <br /> OTHER <br /> BERSON — --� <br /> STATE BUILDING SURCHARGE i <br /> INTANE BY PLANS APPROVED BV CITY OF EVERETT PUBUC WORKS � <br /> LOCAL SALES <br /> pq�� TAX CODE IS 3105 TOTAL � <br />