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APPLICATIQ"' FOR CONSTRUCThN PERMIT � <br /> TO BE COIAPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS ❑ELECTRIC �� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i DEMOLITION ❑ COMBINATION I ! BUILDING .✓,MECHANICAL i 7 PLUMBING ❑ SIGN <br /> OWNER MAILADOPESS CITY ZIP PNONE <br /> � M n � .ytjso T�e.e.occ[�.e E✓ERETr 9lf�o3 �sa - 9s s�� <br /> TENANT MAiI PDDRESS CITV 21P AHONE <br /> nRLHITEGT OR DESIGNER MAIL RO�RESS LITY 21P PHONE <br /> GENERRL CONTRACiOR M�IL ADORE55 CITY ZIP PHONE STATE LIGENSE� <br /> AIEf,NANICAICONiRRCTOR MAILAUDNESS ITY ZIP PHONE STATELICENSER <br /> �!9��-i✓nv ArE.�.l� <br /> �c. EntxGy �rs�rrr,s .Cv.v.vwoon 9P.3G 9��/-�3is .SOE7ocfSo�LTH <br /> PLUMBINGGONTP�CTOR MRILAOD9ESS CITY ZIP PHONE STATELIGENSE� <br /> CONTR�GT PRICE OF WORK <br /> �' po. o 0 <br /> OESCNIBE WORK AND SOURRE FOOTAGE INVOLVE� GONTr1CT^ERSON AND PHONE NO. <br /> -d ii <br /> CsNt F�P ��JaE 7RNaa.� T ��4i�✓ �s+.rK4oG/L <br /> i HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> PHOPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.AlL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br /> LEG�LDESCRIPTIONOFPROPERTYISMOWNBELOWORATTRLHTWOCOPIES� WORK WILL BE COMPLETED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK oF — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW PEGULATIPIG CONSTRUCTION OR THE <br /> PERFOR"1NCE OF CONSTRUCT�ON.THf,T I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCELTA%I.D.NUMBER CONTRACTORS LAW 1�.27 RCW AND 296200 WAC. <br /> �495- D/7 - 002 - o <br /> CONSTRUCTION LORN LENDEFl,AODRE55.TELEPHONE NUMBER <br /> � J�► .-s+G...G.�.— �/c/9 y <br /> PROJECT ADDRE33 sar��runc D.�7/S/ ��E - <br /> piM1 BUSME55 UCENSE NO <br /> PLUMBINO MECHIINICAL <br /> ►p. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. <br /> � BATHTUB ; FORCED AIR SVSTEMS-B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES�RYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> , DISHWASHER fiANOEH00D ' <br /> . LAUNDRV TRAY ' WATER HEATER <br /> CLOTHES WASHEH � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) 1 <br /> ' DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACNFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—f7AINLEADERS E%HAUST FAN ' <br /> SINK(SEFVICE—BAR,ETC.) <br /> � <br /> .. � <br /> � <br /> � <br /> SUB TOTAL $ SUB TOTAL $ O ' <br /> PERMIT S PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE E �/.S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB4CH REARSF.TBRCN SIDESETBACK PUNCHECKNU�ER FEE RECEIPTNO. <br /> d3 <br /> USE20NE LOTARER VAGANTSITE FEES VAI.UATON FEE <br /> I.I YES i� NO BUILDING <br /> 7YPE Of CON57. NO.OF STORIES oc[uceMtv rva m w/fwNGuxrtS <br /> �aWr pLUMBING <br /> i <br /> 52E OF BLDG. FlRE SPRMKLERS REO'D BASEMENT MECHANICAL <br /> f_� YES ❑ NO <br /> OLGUPANCV IOAD fIRE AL�RM REO-D HEIGNT LIMITATION ADDITIONAL FL49 CHECK i <br /> � <br /> O7HER � <br /> REASON <br /> S1ATE BUILDING SUFCHAHGE <br /> MTAHE 0Y PLANS RFPROVEO DY CITY OF EVERETT PUBLIC WORKS � <br /> LOCALSALES � <br /> DAiE TN(CODE IS 3105 ror�� ' <br />