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- . APPLICATIC''1 FOR CONSTRUCT"7N PERMIT � <br /> TO BE COMPL.ETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: 1�1 GAS fb1 ELECTRIC pC <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION IJ BUILDING fJ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER �•�AIL�DORESS ��n' Z�P PHONE <br /> �/oN�4Rl�'Sr�h1J�ID�`�2 h�Yl NCI�O S�AT7'�-F %�/5"� �iPS—�'/�3 - <br /> TENANT MAILA�ORE55 GITV ZIP PHONE <br /> ARCHITECTORDESIGNER M/IlAOPRESS CITV 21P PHONE <br /> GENERALGONTRALTOq � MAILADORE55 CITV ZIP PNONE STAiELICENSE• <br /> � f�. .4�h�F r�F,� ??/9 T/L,�Li P �44f�Fl�ETT '��'.S`-��Z 3 — <br /> MEGNANILALCONiRACTOR MRILpODRESS <br /> CI Y 21P � PdONE STRTEUCENSE <br /> PLUMBING G04TRACTOR MRIL AD�RE55 CITY ZIP PNONE STATE UCENSE� <br /> CONTRRGT PPICE OF WOFK <br /> �ESCRIBE WORK RND SOUpNE FOOTAGE INVOLVED - CONTACi PERSON ANO PHONE NO� �i = - <br /> �ni yJ !>___ro/�P_ff ,��-A,1D � <br /> )�- /1 - , �' - '� �h R� 5� g� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USEOF BUiLDING APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SHOWNBELOWORRTTAGHTWOGOVIES� WORK WILL BE COMPLETED WITH WHETHER SPEqFIED HEREIN OR <br /> ��� �� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iarJ�— e�aK � '� wy� AUTHOHITY TO VIOLATE OR CANCEL 7HE PROVISIONS OF ANY <br /> .�T,4 NHnR D �.,1 �/b G G�S_�AI�D /O G V 'R� pERFO MANCE OF OONSTRUCTION.THAfG AM AUTHO I�D BV THE <br /> '��CE p.'/`(PC�-1�J OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> 'I APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARGEL T �D NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> l�,3�j - �3 �v � - �O / <br /> GONSTFUCTION LOAN L OEP,ADDflE55.TELEPHONE NUAIpER I ' �/���� <br /> / _ <br /> • G!� <br /> s emae o��e <br /> PROJECT ADDRESS�3/ �� / <br /> q�(J LilYBu5nE55UCEN5EN0 <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSF.T(TOILEn � NC—A�HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. Rt E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> � CLOTHES DRYERS <br /> SHOWER � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER � RANGEl100D <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVG ' <br /> URINAI METAL FIREPLAGE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DFiAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> SUB TOTAL 5 ' SUB TOTAL $ <br /> PERMIT $ � PERMIT S <br /> TOTALFEE S TOTAIFEE S <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO. <br /> FRONTSETBACK REARSETBACK $I�ESETBACK PIRNCHECHI� ER �EE <br /> USE20NE WTAREA <br /> VAG�NT SITE FEES VALUATION FEE <br /> C YES ❑ NO BUII.DING QO �' I ' � <br /> NO.OFSTOBIES OCcdP4vGv NOOIPVEWMGUxits � <br /> MEOFCON57 � ewp, � PLUMBING ' <br /> S � <br /> SIZEOFfiLDG. FIRESPNINKLERSREO'0 BASEMENT MECHHNICAL � <br /> ENSY�r /�(.O fl YES ❑ NO <br /> OCGUPANCY LOAD FIRE PLARM REO'0 HEIGHT LIMITATION ADDITIONAL PLAN CHECK �, lOS <br /> i <br /> q �JV A OTHER _�_ <br /> REASON � C-'L7 <br /> STA7E BUILDMG SURCHARGE <br /> -� <br /> iNTpKe ev �'LPNS naPnoyeoer CITY OF EVERETT PUBUC WORKS <br /> � �f LOCAL SALES � <br /> oF,E Z �'3 TAX CODE IS 3105 70TAL � � /5 <br />