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APPLICATIC �1 FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BI.ACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION BUILDING ❑MECHANICAI ❑PLUMBING ❑ SIGN <br /> OWNEP MAILRDDRE55 CITY ZIP PHONE <br /> Gac� ��,vcr/ 3�i¢ ���r�+ Gv. ��Zoi i-�� -3Z� -_ �r�� <br /> TEN�NT M�IL ADDRESS CITY ZIP PNONE <br /> (��R�� S�,�DI� <br /> RRCHITEGT DESIGNER MA1 �DDRESS CIiY ZIP PMONE <br /> �� <br /> GENERALCONTR�CTOR M�ILADDRESS CITV 21P PMONE STATELICENSEs (`.�CL�KIUQ <br /> �c,BIZ�IJI� CUiU�� R�zSG��Rcfi._S �NC ZZ/- N�c:K�i/LSciJ ,Sl:af- �'361c��28:37/z/ �`14J'L� <br /> MECH�NIC/�L CONTRACTOR M41L ADDRESS dTY ZIP PMONE uTqTE LILEIlS�• <br /> PLUMBING CONTAAGTOR MAIL ADDRESS dTY ZIP PMONE ST�TE LICEY.SE� <br /> CONTR�CT PRICE OF WORK <br /> � ODO •C7U <br /> DESCRIBE WORK AND SOIIFRE FOOTAGE INVOLVED CONTqCT PERSON AND PHONE N0. <br /> G'1�/�IYZ W r O r ' WiFGL '� �' /' G ZL3 -7 � <br /> ' T ` <br /> L)0.vr�aa�POL YJ�1 IfU_ i HEREBY CERTIFV 7HAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOF wiowc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> LEG�LDESGRIPTIONOFPROPERTY�SHOWNBELOWORRTTACHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETliER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior — e�ocK oF .— AUTH091TY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> OTHER:TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFnRMANCE OF COiVSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL T�%ID.NUMBER CONTRACTORS lAW 1827 CW AND 296.200 WAC. <br /> 57coo C7C� ' CJ 7C) ` 3 � <br /> CONSTHUCTION IOAN LENOER,pODRE55,TELEPHONE NUMBER �Z'��ZSS �/� <br /> K¢ � F Q 1 c3� �u i / <br /> PROJ(E�CT DDRESS +1 si une oeit <br /> �IDI� SW�� ` LIiYBUSM�.SStICENSfNO <br /> PLUMBIN(i MECHANICAL <br /> N0. TYPE OF flXTURE UR ITEM FEE NO. riPE OF EOUIPMENT FEE <br /> WATEA CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) i UNIT HEATERS—B.T.U. M ; _ <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DHINK�NG FOUNTA�N � FIREPLACE INSERT <br /> FLOOA DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF ORAINS--RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT S � PERMIT $ <br /> SOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBFLN REAR SF.TBACR SIDE SETBACK PLAN CME H NUMBER FEE RECEIPT NO. <br /> s7� � <br /> USE ZONE LOT AREA VPGANT SITE FEES VALUATION FEE <br /> J VES C NO gUILDING p�- �O�� <br /> iYPEOFGONSi. NOAFoTORIES acu»xa xJao-MumGUNrtS <br /> eaouP p1.UMBING ' <br /> SREOFBLDG. FIRESPRINKLERSREC� BASEMENT MECH4NICAL � <br /> ❑ YES ❑ NO <br /> OCGUPANCV LOAO FINE FLAPM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHEFi <br /> RE/.SON �� 1 <br /> STATE BUILDING SURCHARGE �S V <br /> INTr1KE BV i'LRNS APPFOVED B" CITY OF EVERETT PUBLIC WOiiK$ � <br /> LOCAL SALES <br /> onre TAX CODE IS 3105 TOTAL - � ���j <br />