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APPLICATIC'1 FOR CQ`NSTRUCT''�N PERMIT � <br /> TO BE COMPLETED IN BLAGK INK�LEASE PRINT <br /> HEATING SYSTEM: [�GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> z59-�,0 �I hy .� <br /> I1 DEMOLITION/O COMBINATI� Cl BUILDING 11MECHANICAL []PLUMBING i� SIGN <br /> OWIJER MAILADDRESS pTV ZIP PHONE <br /> x ��-� - - ���� k- z=, r ���- ��, 1�--,, �,��-c-- <br /> TEN� 1 . M�RMOR 55 CITY 21P PHONE <br /> I ,� <br /> f"A M'J/ �-I/f/ � Z.1 Li/lltJ <br /> RRCMREfT.n.DESIGNER MAII ADDRE55 CITV 21P PHONE <br /> X <br /> GENERfLLCONTqpCCOR MnILA0DRE55 dTY ZIP PHONE STATELILENSE• <br /> ��� �UJ►� E/t/ <br /> MECH�NICALCONTRRf,iOR M41��DDRE55 CITY 21P PMONE ST�TELICENSEt <br /> PLUMBING GONTRACTOR MFIL ADDRESS GITV ZIP PHONE STpTE LICENSE� <br /> CONiRACi PFiCE OF�WOqK <br /> � Sbao , �2 uc. <br /> DESCPIBE WORK RND SOU�PE F�TAGE INVOlVEO t, t � u � CANUGT PERSON RND PNONE NO. <br /> V <br /> � IJS�LI.f� ..f'D '� Iti1J U F , ' «'� . <br /> lu� �-'���Z ��'t' �` � i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BWLDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> � PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCR�PTIONOFPRWERTYISMOMHBELOWORATIRCHTWOCAPIE51 WORK WILL BE COMPLETED WITH WHETHER SPEGPIED NEHEIN OR <br /> NOT. THE G�.;NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORII I TO VtOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK fOF WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PRFCEL x i.o.r+uMeea CONTRA RS 78.27 CW AND 29Fi200 WAC. <br /> GONST UCiIONIO�NLENDER,AODPESS,TELEPHONENUMBER ��� <br /> PROJECT ADDRESS swH�.u�e n�rz <br /> /D �� �/O � � GTv11lI9ME5516EM5FN0 <br /> p����y MECHANICAL <br /> Np. TYPE Of flXTURE OII ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER(.iOSET(TOILET� A/C—AMNDLG UN�?S—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYEPS _ <br /> KITCNEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> UUNORY TRAY ; WATER HEATEA ` <br /> CLOTHES WASMER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETCJ <br /> SUB TJTAL $ SUB TOTAL $ <br /> PERMIT $ PERIdIT $ <br /> TOTALFEE 5 TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCK REPR SETBACN SIDE SETBALK PIAN CHECN NOMBER FEE RECEIPT t O. <br /> USE ZONE LOi AREA VACANT SITE FEES VA�UATION FEE <br /> :_! YES C NO BUILDING 'rj UUL` J <br /> iVP[7FCON5T NO.OFSWFIES ocCeou,¢r x0aow[wxGuxns <br /> 0P011° PWMBING <br /> SIZE OF BLOG. FIRE SPRINKLERS REO'0 BASEMEN7 MECHANIGAL <br /> ❑ YES i�l NO <br /> OCCUPANCYLO�D FIREAURAIREOD HEIGMTLIMRATION ADDITIONALPLANCMECK <br /> OTHER <br /> REPSON <br /> STRTE BUILDING SURCNARGE <br /> INTRKE BV PLANS PPPROVED BV CITY OF EVERETT PUBIIC WORK$ � <br /> LOCAL SIILES <br /> oq,E`� TI1X CODE IS�/05 ror�� 7 ;�j� <br />