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APPLICATIO"� FOR CONSTRUCTI`�N P .r;''�'.' <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: :�1 GAS ❑ELECTRIC `1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> � DEMOLITION � I COMBINATION i=i BUILDING �MECHANICAL [-i pLUMBING : SIGN <br /> OYJNER /� MAL ADORE55 C�TY �G Z,p p�'ONE —7 <br /> �e5 �d'u .wc{�s ��'lG� U;�or �� �erv.�( L('d ��G� 'IS`�'7/�/ I <br /> TENANT MRILADDRESS CIiY 2iP PHONE <br /> FRGMREC70RDES�GNER A1FI�ADDRE55 CIiY ZIP PNONE <br /> GENERFL CONTRAGiOR kAll FDORESS CITV ZIP PMONE STATE UCEl:SE� <br /> S"P�J�c,.� �ea��r�, ��U- � s �33y�-/ SCAfII o D <br /> MEGMANICALCONiRAGTOP MA�LNODRE55 CI�Y LP PNONE STFTEUCENSE <br /> PWMBINGCONTRAGIOR M/•ILADORE55 dtt IIP PHONE STATEUCENSEb <br /> GONiRACTPRICEOfWORK CC <br /> fo S— <br /> OESCRIBE\YORK AND SOURRE FOOTAGE INVOLVED CONTACT PEF504�ND PHONE Np. � ��/ <br /> �1� brfu 1� �v� r�w. W✓ 0 Ou.:��e z5 A".�.u-A'S ,���-Uic7�-Y�. <br /> o. <br /> I // �, p <br /> ��...n l��� „-1-��.A�lyi[) 5' ��P- / D� I HEREBY CERTIFY THAT I HAVc REAC AND EXAM�NED THIS <br /> PFOPOS[0 USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGALOESCRIPTIONOFPROPERN�SHOWNBELOWORATIALNTWOCOFIES) N�R 7HELGRA T NG OF A ERMITJDOES NOT PRESUtdEETO GNE <br /> �or eiaK-- oF qUTHORITY TO VIOLATE OR CANCEL THE PAOVISIONS OF ANV <br /> OTHE(7 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNCR OF THIS PPOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnncei-tnz i.o.rvuraeeA CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> WNSTR11GT10NLOANLENDER.AOORESS.TELEPMONENUMBER � /� __ _ / /�_�J <br /> Niricp ij 1 <br /> ... u unc o,rt <br /> PROJECT ADDRESS <br /> • �1" i 11C1• cnvnusn+rss��ctvs[Ho <br /> PLUMBING ✓ MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE _ <br /> WAT�R CLOSET(TOILET) AIC—AMNDLG UNITS—H.P. <br /> OATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M __� <br /> CLOTHES DRYERS <br /> SHOWER � <br /> KITCHEN SINK&DISP VENTII.ATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUhDRYTRAY WATER HEATER <br /> CLOTHES WASHER VJOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNWG) <br /> DRINKING FOUNTAIN FIREPLACE INSEFT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUS?FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUB TOTAL $ SUB TOTAL 5 /,'J ' <br /> PERMIT $ _ PERMIT $ / <br /> TOYALFEE S ' TOTALFEE S <br /> FOR OFFICE USE ONLY: Receivr r+o <br /> FRONiSETB4CN �EARSETBALK SI�ESET�4CK PLANLNFLNNl1MBER FEE <br /> VACPNTSITE FEES VALUATION FEE <br /> USE7.ONE ��TARE` i <br /> i'' YES ❑ NO BUILDING <br /> �1'PE 01 CON57. NO.OF STOalES aturarya HO a frcrtuiNLcxi�s <br /> saou- PLUMBINCi <br /> SIZ:EOFB�OG. FIFESPRINNLERSREO'D BRSEMENT MECHANICAL <br /> ❑ YES ❑ NO <br /> AD�ITIONAL PLAN CHECK ' <br /> OGCUPANCY LOAO FlFE AL4RM R[O-� HEIGNT UTAiTFTION � <br /> OTHER <br /> R[PSON <br /> STATE BUILDING SURCHPFGE <br /> INT�KF BV PLANS APPRUVEDBY CITY OF EVERETT PUDLIC WORK$ <br /> LOCAL SALES <br /> oA,E TAX CODE IS 3105 TaTA� <br />