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APPLICATIC 1 FOR CONSTRUCT'"'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />y��5� <br />I HEATING SYSTEM: �24 GAS U ELECTRIC :�,_ _� <br />BUILDING DEPARTMENT <br />259-8810 <br />i l DEMOUTION ! I COMBINATION �! BUILDING ;i( MECHANICAL I! PLUh1BING i SIUN <br />OWNRISIO NCK nLAD/`/SG��L _/�G�uscLll �'✓Z2. r PMONE <br />� �� �_ E,,��eif i.u� 98�0/ �SY-/275 <br />G y— <br />TENANL MAILAD�RESS GITV ZiP PNONE <br />SA� E z <br />ARCNRECTORDESIGNER MAILADf]RE55 CITY ZIP PHONf <br />fENENALGONTRACTOR MAILA��RESS CITV ZIP PHONE STATELICENSF� <br />PLCONTPRCTOR AIAIL <br />S.lY'JJb�-�- <br />GONTRACTOR h1A�L <br />GONiRAGiPFICEOf\Y�K �O _ <br />-F� a ,' � <br />DESCRI�E 1VORK AND SOUARE FJOIAGE INVOW EO <br />a <br />G TV ZIP <br />CIiY Zlf <br />� �1 <br /><'� bN� <br />GONiFCTPEF <br />�l. <br />I-,�.�N�C2 i <br />PMONE STATE UCENSE • <br />PHONE STATE LICENSE ♦ <br />/L't/LL. 2SS�'/ � ��' <br />i HEREBY CERTIFY THAT 1 HAVE RCAD AND EXAMINED THIS <br />PFiOPOSEDUSE OF BUILDING APPLICATION AND KNOW THE SAME TO EE TRUE AND CORRECT. ALL <br />�' r � PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />LEGALDGSCRIPTIONOFPROPEiiTVI5H014NBELOWORATTAMCHTWOGOP1E51 u f� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT� A��K 34 aF QLlfl c,�CN2t�1/ I�'��dc.� NOT. THE GR�NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />frIy/ /C��� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />��!J �� H I i-{' I-� j 3 A�'�t%� 1/-Z Sc.t�� OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR TH[ <br />� -{- PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />�(J �t o J �c' I �C • V I �{i�F S fy. 1%� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICF <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE. <br />��nace� rnx i o nue�oea CONTRACTORS LAW 18.27 RCW AND 296.200�1NAC. <br />� _ ���� Z � L�a.�s i �_ � . <br />�+��8-3.sY � ' �—' -'�2 — y <br />CONSTRUCTION,OPN}EN��ADDr�E $ j"{CPu�IIUM�✓t' � u �l '� f� � �������_y <br />fp "/ M_/ ( PI-el� I.(i%f.`%Jjp .✓L -1 � �J <br />M1.1 16 .� � �«,o �- <br />PROJECT ADDFESS ��cr � �e �"� <br />GtV BUSINE54 LiLFNSC 110 <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIICTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />WATER GLOSET (TOILET) A/C—A�HNDLG UNITS—H.P. <br />BATHTUB FORCED AIR SVSTE�AS—B.T.U. M E.A. <br />LAVATGAY (WASH BASIN) _ UNIT HEA7ERS—B.T.U. M _T_ <br />SHOWEF. CLOTHESDRYERS ' _ <br />ICITCHEN SINK 8 DISP VENTILATION fAN �_ <br />DISHWASHER RANGE HOOD ' <br />LAUNDRY TRAY ___� WATER HEATER � <br />CLOTHES WASHER � WOOD STOVE <br />URINAL _� _ H'�TAL FIREPLACE (WOOD BURNING� _ <br />DRINKING FOUNTAIN FIREPIACE INSERT � <br />FIOOR DRAIN � HEAT PUMP <br />BACKFLOW PREVENTERS GAS PIPING -(e �y�,,,�,�,� ,_ <br />ROOF DRAINS—RAINLEADERS E%HAUST FAN _ <br />SINK (SERVICE—BAR. ETQ) � <br />' -- <br />FOR OFFICE USE ONLY: <br />FRONiSETBACN REM SETpaCK <br />USI:ION[ LOT4PEA <br />iVfEOiCONSi. NOAFSTORIE: <br />SiZ[ OF B�D�. <br />OCGUPANG�LOAO <br />FEASON <br />ir�rnk[ ev <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE 3 <br />FIRE SPRINKLGRS REO'D <br />FlRE AL0.RN. fiEOD <br />on,r <br />ev <br />vinrv cr+Ec� NurnoEn <br />VpCANT SITE r CCJ <br />-� YES -' N'� BUILDING <br />ccm�-vcv noo�a+hwxcwuis - <br />�eo�v PLUA781NG <br />enSEMENr 1dECHANICAI <br />I l YES : �. NO — -- <br />HEIGNT LIMITATION ADDITIONAL PLAN CNECK <br />GTHER <br />S7ATE BU�LDING SURCHARGC <br />CITY OF EVERETT Nuou;. woaKs <br />LOCAL SALES <br />TAX CODE IS 31D5 TOTAL <br />SUB TOTAI 5 O; O� <br />PERMIT 5 ��OG� <br />TOTAL FEE S y[,� <br />R[CEIPT NO <br />VALUATION FEE <br />T <br />— —�— <br />i <br />