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APPLICATIC"1 FOR CONSTRJCT�`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTIv1ENT L <br />259-8810 <br />i I DEMOUTION i I COMBINATION <br />OWN6R h1�IL��DRF.55 <br />i� hc�n /7r � lam ,f'liu.H <br />TENANT h1AIL�ODRESS <br />�RCHRECTORO°SICNER 1 � A 0 <br />HEATING SYSTEM: '.� GAS <br />I I BUILDING <br />CIiY <br />Y W �st <br />CIiV <br />IJ <br />I I MECHANICAL <br />ZIP �v� PI/ONE <br />a�//v� n _,4✓ <br />ZIP � PMONE <br />I I PLUM8ING I i SIGN <br />:ay 3sro'7,Z; <br />1 IL � RESS GIiV 21P PHONE <br />� r!/� /f ec/i ✓ ���3a t' /37/ cc5'n+�ic �nirz�r �� ?YyY/ s`�i'-9Y�� Neci�oB,<3a�J'i _ <br />GENCfl�LCONiR4CTUR IdpILAD�RESS PMONE ST�iELIC[NS[� <br />nfl 3 <br />MECM�NIC�LCONTiiACTOR MNLAD�RE55 CIiY ZIP PHONE ST4TELICENSE+ <br />PWMBINGLONTRFCTOR MN�ADDRE55 CITY 21P PHONE STAIEUCENSh� <br />CONTRpCT PFICE OF 140RK <br />FOOTAGE <br />��, r�•, t+c <br />o S9, �F' T <br />Qr�/n �7�rc�1 ��'S���o6 <br />CONiACT PERSON AND PMONE NO. <br />r <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />PROPOSED USE OP 9UILDING APPUCATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />. u{/o r d � r� �� t� .R., l-r J� ��� e PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGA�DESCflIPTIONOFPROPERTV�StlOWNBELO� ORATT�CHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br />�or 3 p��K � aF �H �'er C/r�_ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GWE <br />� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />��✓/ o/a.� N4 I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br />PERFORAIANCE OF CONSTFiUCTION. THAT I AM AUTHORIZED BV THE <br />OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />PARCELTA%I un�oea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />[��pa O�� �3 � �� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />CONSTRUCIIONIOqNLENDER.�DDRE55.TELEPHONENUMBER <br />t' y � /�[� (� [�� �% � <br />� {✓CYt /%pr( f y S— 7( ( %i.XM /A—C/'t �Gy �% �i� <br />PRO�JECT ADORESS acvmm�=_ q�� <br />cnv aus�ncss i icFnst �ro � <br />PLUMBING MECHANICAL <br />NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br />WATER CLOSET (TOILET) A�C—AiHNDLG UNITS—H.P. <br />BATHTUB ; FORCEO AIR SYSTEMS—B.T.U. M E.A. � <br />LAVPTORY (WASH BASIN) � J UNIT HEATERS—B.T.U. M_� � <br />SHOWER CLOTHES ORYERS � " <br />KITCHEN SINK 8 DISP ; VENTILATION FAN � � <br />DISHWASHER RANGE HOOD <br />IAUNDRY TRAY ' WATER HEATER <br />CLOTHES WASHER WOODSTOVE � <br />URINAL � METAL FIREPLACE (WOOD BURNING) � <br />DRINKING FOUN7AIN � FIREPLACE INSERT � <br />FLOOR DRAIN � HEAT PUMP �— <br />--�— � <br />BACKFLOW PREVEN7ERS GAS PIPING <br />ROOF DRAINS—RAINLEADERS EXHAUST FAN <br />SINK ISERVICE—Raa FTr. � � <br />SUB TOTAL <br />PERMIT <br />FOR OFFICE USE ONLY: Sm0 <br />Ffi0Hi5ETBAGK REARSET�ACK <br />USE 20NE <br />iYPE. O�f C-�01151. <br />�_ <br />SIZE OF BLDf <br />2�f S,F. <br />OCCUPANCVLOAD <br />RE�50� <br />INTAKE BV <br />LOT AREA <br />NO OF STORIES <br />PIRE SPPINNLEFS REO'0 <br />�o <br />FlRE �L�RA1 REO�O <br />P�ANSAPPRpYED�V <br />�ATE �. / � / <br />SETBFCK <br />u�� <br />� <br />FEE <br />� : YES i- NO BUiLDwG <br />acaravcr r,no�mvuuyc�r:ns <br />9,,.� <br />� • 3 I PLUh181NG <br />B�SEh1ENT MECHANICAL <br />- vEs v�io <br />HEIGHTLIMIT�TION AODITIONALPLANCHECK <br />iJ �j / <br />� OThIER <br />STATE BUILDING SURCF'1RGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3705 TOTAL <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S �— <br />RECEIPT NO. <br />VALUATION FEE <br />) C'I � — <br />� <br />i <br />i <br />;� i � <br />i <br />_ V � <br />i <br />� <br />