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APPLICATIC -1 FOR CONSTRUCT' 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—pLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: J GAS �yELECTRIC J <br />259-8810 <br />✓ <br />DEMOLITION COMBINATION I I BUILDING MECHANICAL I PLUMBING ; i SIGN <br />�OI/YNER M4ILADGRESS Cii" 21P PNONE <br />itiu►es It9� T.k�, ,1�R. a5i3 TiyYtoR EU�,triT 9�.io� 7�f 5-S/`�65 <br />TENANT MAILADORESS C(V 21P PHONE <br />ARCMITECTORUESIGtlER MAILADDFE55 Gtt IIP PNONE <br />y� GENERALCONiRACTOfi h1AllADORE55 CITV ZIP pNONE SiATELICENSEa <br />�"7�a��s W� f�,.s ,TR, .7.f13 Ti41'�oR ,FvPnPA qBzo� 7b`S-S96S <br />MECHANICRLCONTRACTOR �IAILAODPESS GTY ZIP PHONE SThTELICENSE/ <br />PLUMBINGCONTRACTOR IAAILApOFE55 pTY ZiP PMONE STATELICENSEI <br />CONTRRCT PFICE OF WORK <br />{� � DESCRIBE WOPK qND 50UARE FOOTAGG INVOWE� CONtACT PEP50N AND PHON[ N0. <br />:��' Pmoc/fN 2 NR /3/fA9P <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />� PFOPOSEDUSEOi BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />/I'P6/OP.vY/ N L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 1YPE OF <br />LEGALDESCFiPT10NOfPROP[PTY�SHOWNBELOWORFTTACMTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />ior—� B�ocn ___L— oF E�PRN? NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTFUCTION. THAT I AM AUTHORI2E0 BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />rnAr.Fi rnvin NiIMPFR /� APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />7/%O 'OD I— OOT ' DOO % CONTRACTORS LAW 18.2i RCW AfJD 296.200 WAC. <br />CONSTq�CT10N LOAN LENDER. ADDRE55, TELEPHONE NUMpER �///i /�% /J� , / /J�` <br />PROJECTADDRESS � ��y� �� <br />� .�.JrD /% LO srovn�unr wrt <br />cnrou;wrssi.¢rnsr ��o <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FFF <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAO <br />SINK (SERVICE—BAR, ETC <br />TOTAL 5 <br />v11T $ <br />�L FEE 5 <br />FOR OFFICE USE ONLY: <br />PRONTSETO�CK REAF: <br />U5820NE IOTAP <br />iMkOFCONSi. NO-OF <br />Si2E O- BIDG f IRE SPqINKlERS RE00 <br />OCCUPANCY L04D FIRE AlAqk REO D <br />REh50N <br />iNi�K[ BY PLANS APPpOV[D DY <br />onre <br />SIDE <br />r�7RCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VEVTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PL�NCHE WN �AS�/ <br />:.y y <br />�� YES . _� NO BUILDING <br />accuwuv xoa�owniwcuw�s <br />eAow p�UMBMG <br />BnSEMENi MECHANICAL <br />VES f NO <br />HEiGHT uMiTnT1oN ADDITIONPL PLAN CHECK <br />OTHER <br />STATE BUILDIYG SURCHARGE <br />CITY OF EVERETT ruouc woaKs <br />LOCAL SALES <br />TAX CODf. IS 3105 rorn� <br />FEE <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE S <br />0 <br />