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APPLICATIC ) FOR CONSTRUCT )N PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT I HEATIN3 SYSTEM: �GAS J ELECTRIC J <br /> 259-8810 <br /> DEMOLITION COMBINATION 'X BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAILADORE55 CIiY ZIP PNONE <br /> DoPy�n1 C�,Us;,�eirD�1I�D[�.i�JC- P D SDX � �s ��,,J�1 9aaa3- ��.�)�5�2-5761 <br /> TCNAHT IAAIL qDDRESS CITY ZiP (�'�}�j PIIONE <br /> 4RCHIiECTORD@SIGN[fi Id41LADORESS CITY ZIP PHONE <br /> NGQTit6JC-55� Nfl�)!E_�-s r��l Y 9a 8 /Q9��y�Rcc i s uJ. ��Ccnrif cJf) 9�y 9't (�G)�'�y-6 3���i <br /> G[NERALCONTR4CTOR MAILADDRESS CITY ZiP PIIONE STATEI.ICENSE• <br /> � �l ConJs�reiro,� P� o (3�x ��3,_E-�IER��,J� 9�a��3 - (�)C�3J1�i�C��K�cD1z7Dk <br /> MECHANIGAILONTHACtOR MAILApDRE55 ��T� ZIP o�73 PHONE STFTEUCENSEs <br /> PLUMOiNGCONiRACTOR MAILAD�FESS CIiV ZIP PMONE STATELICENSE� <br /> CL�55OF WORK <br /> X NEW AD�ITION ALTERATION REPAIR DEMOLITION WOODSTOVEiFFPL INSERT BUILDING RELOCA��ION <br /> /,� � /L���n� CONTACTP[RSONANDPHCYENO. <br /> 1�Q � <br /> coNrnncrvniceoFwoarc-�}Q D7171, �o - "7 <br /> o�scaise woaK nNo sauaae Foomce iNvo�veo �/�C({ $/AG- <br /> L�i�x_r�i,�t��r�r,�,,��r-�a,aGr Jayys�,�r . <br /> Paoaoseouseorem�oiNc 2�9 5Q+-T.�.GQQ. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ' tJUI�C/Y TJq Nl/i�l.lSC F?J/Z S/3LB APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �ecnioesemPnoNOFPaoaearv�srrowrvoEtowoanrincNvouacowes� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHEfl SPEGFIED HEREIN 6R <br /> �or o�ocrc . oF NOT. THE (3�RANTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br /> �?17�HLLfc� AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �^!J h�i�C/��:��=� F%T��=�� •�6�A ' OTHER STAI"E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' PERFORMANCE OF CONSTRUCTION.THFT I AM AUTHOHIZEO RY THE <br /> ^WNER OF THIS PROPERTY TO PERFORM THE WORK FOR �VHICH <br /> � APPI.ICATI IS MADE AND I COMPLY WITH 7HE STATE <br /> � CONTRAC RS AW 18.27 RCW AN�256200''NAC. <br /> ` 1 1 <br /> �- , .. � <br /> r <br /> � J• X � � � \q��.� . V. <br /> PR JECTApDRE55 f Sc��mvv��. 0 rt <br /> � ���LR OV ` CiIYAlI5MC55UCry5FN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WPl EH CLOSET(TOILET) /C—A/HNDLG UNITS—H.P. _ <br /> THTUB F CEDAI9 'aVSTEMS—B.T.U. M E.A. <br /> LA �iTORY(WASH BASIN) i UNI HEATEFlS—B.T.U. M <br /> SHO ER n n7 FS DFYERS <br /> KITCH �SINh S DISP <br /> DISHWA ER T � � y�✓i�` --� <br /> LAUNDRY AY �_ <br /> CLOTHES WA HER � <br /> URIN.4L ' <br /> �� �c h.,t, ��� z" <br /> DRINKI— N�F��N�1�N wn��- <br /> FLOOR DRAIN '�� ' <br /> BACKFLOW PREVENTERS �' "� �eg5 �� �-�(j"'��'�� '�-"''" <br /> _ ROOF DRAINS—FAINLEADERS ' �'' ����,�_s <br /> SINK(SERVICE—BAR,ETC.) <br /> — � ����, i <br /> � <br /> ���5 �-��y�' ��-C Gt'�n,^ri�+rt� <br /> SUBTOTAL S ' 4�c S��y� ,1. � <br /> PERMIT 5 �— -� � <br /> r <br /> TOTAL FEE 5 > ' <br /> FOR OFFICE USE ONLY: /��07�/�-� / .� <br /> FRONTSETB�CH RF.�IIS[Tf1ACN SiD[SETBACK PLANCM[LNNIINpER FEE R[CEIPTNO <br /> �v 2�� /o ' - 5 ' _3 3.�� �llr3. `�� �9l <br /> usezorve �ornqen vacnN-srte FEES VALUATION FEE <br /> �.��_ ^' �S b� h BUIL�RJG Z6 3 _��L, � <br /> 1vPt0{WNiS.A-.IOWAAIE iYPEOfLONSt.ACipql Oc[d�^>tLv ri00�p4EWNGNi�15 -- <br /> � /v —� nnn�.�r A Z p�UlA81NG �—� <br /> "T <br /> �i2[5OFpIDG NOofSTORIEs 6n£EM[NT MECHANICAL .-1- <br /> �Z6Y SF GAR U . <br /> ADDITIONAL PLAN CHECK � <br /> OCCUPANCYIOAD Flii[54'RNNLEli5RE0'D NEIGHTLIMITATI04 _ ,C3 �G�_ <br /> � 3s ��---� , 2C �- <br /> RF�50 �ORSPRINNL[RS — _ <br /> STATE BUILDING SURCHARGE � '1 <br /> ir�rnke ev —�i�inNs nnrnovr�Av CITY OF EVERETT PUOLIC WORKS — <br /> LOCAL SALES � '—'— <br /> JI-� ��3/�3 TAX CODE IS 31D5 rorn� � i- j j� <br />