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. ,.� <br /> APPLICATIG_J FOR CONSTRUCT.JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIN: <br /> BUILDlNG DEPARTMENT HEATING SYSTEM: ��GAS ❑ELECTRIC J . <br /> 259-8810 <br /> �DEMOLITION �COMBINATION I l BUILDING i�MECHANICAL ❑ PLUMBING O SIGN <br /> OWNE MAILADDRESS CITY ZIP PNOdE <br /> �If^crER �.1�. G��oicF �R. c�20 y�� 5� S� G✓�2tr� � 9S�zd3 7S2-Zy31 <br /> TENANT MAIL�DDRESS GTV Z'� PNONE <br /> /J0�1E �i'r �RP�L�T <br /> APCHITECT OR DESIGNER MAIL AD�RESS CITY ZIP PHONE <br /> A�'/T <br /> GENERALCONTRACTOR MAILADDRE55 CITY ZIP PHONE STATEL�CENSE� <br /> n!IA <br /> MECMANICALCONTRACTOP MAILA�DRESS Cltt ZIP PMONE STRTELIGENSE� <br /> Al��i <br /> PLUMBINGCONTRAGTOR MAILADDRESS piV ZIP PHON@ STATELIGENSE/ <br /> ) <br /> CONTRACT PRICE OP V/ORK <br /> \� <br /> DESCRIPE WORK AND oOUARE FOOTAGE INVOLVEq CONiA T PERSON ANO PMONE NO. <br /> In�6rrio.- temedel. �w s��eMtk „� �tlw ro�m � t'Za2 6U�OIC- Q SZ-Z � 771'bSi�O Wk) <br /> nro t wos�+ � nddi i3��.ns�a�. �� _ <br /> 0. UOSC.T M IJe�rUDM I SJJhC EIfC,�Tq� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILOING I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Sprqlt_ �qry��`7 f�.MF PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESCPI IONOFPROPERT �SNOWNBE�OWORATTACHTWOCOPIES) WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tot 2��ZZ' eLoGK S02 oF M;ky land ca�+pan�ts, fhrrd NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE <br /> �Id�Ml1 �a �'�+Ytl• A=��'h7 +1�c ��at ttd • Rem tJ �^ `��+�c y AUTHORITV TO VIOLATE OR CANCEL THE PflOVI510NS OF ANY <br /> AL Di..m OAt,F 3S. RKadc bG Sno�amlSl+ �n.n'�y� IAJAe1��J'�N OTHEF STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 5�59-soz�ozl -da�q OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> Z APPLICATION IS MADE AN I COMPLY WITH THE STATE <br /> PARCEL TAX I D NUMBER L CONTRACT RS LAW 1827 RCW ND 296200 WAC. <br /> CONSTRT'UCTION LO N LENDER,ADDRESS.TELEPMONE NUMBER <br /> nl��f a � <br /> PflOJECT ADDRESS sicN.unc ��E <br /> 23�0 MR�I.E 3{Y�2FT� EUE�R£YI� l.�R cnvouvrvessucer+ser+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EDUIPMENT FEE <br /> . WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN) t�AcE UM.1' i UNIT HrATERS—B.T.U. M i <br /> SHOWER ' CLOTHES�RYERS ' <br /> KITCHEN SINK 8 DISP R��� �Y VENTILATION FAN � <br /> DISHWASHER qDQ � RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER hL <br /> � <br /> CLOTHES WASHER — � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) I � <br /> � <br /> � � <br /> SUEITOTAL $ ' SUBTOTAL $ 1 <br /> PERMIT $ � PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FPONTS[TBACN REARSETBACK SI�ESETB�GK PL4NCHECNNUMBER FEE RECEIPTNO. <br /> usezorve LOTAREA VAC�NTSITE FEES YALUATION FEE <br /> l�- YES �-: NO 7 ' <br /> BUILDING ' � <br /> TYPEOFLONSi. NOAFSTORIES ttf�.a'.4cr NonreW[t,�xGUNns — 1— <br /> eao..�r PLUMBING i <br /> i <br /> SIZEOFOIDG. FIRESPRINKLERSREO'0 BASEMENT MECHANICAL � <br /> -1 YES ❑ NO � <br /> OCCUPANCVLOf.D FIREALARMPEO'D NEIGHTLIMIiAT10N ADDITIONALPLANCHECK � <br /> i <br /> OTHER i <br /> REASON i <br /> STATE BUILDIN3 SURCHARGF <br /> MTAKE 9V PL4NS APPPOVEOOV CITY OF EVERETT PUE3UC WORKS i <br /> LOCALSALES <br /> onre TAX CODE IS 3705 TOTAL ;� <br />