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_..-.::� �;: . _ <br /> -,-=�r�; S . ._ _ - : <br /> �s;:�:; <br /> �-��-_ ���' APPLI�ATIOPI FOFi C01dS�41�lJCT10N PEF�MIT �✓�" <br /> �.;�,r_ <br /> f''��'�.�'i TO BE COMPLET.ED IN BLACK INK—FLEASE PRINT <br /> DUILDING DEPARTMENT HEr _r�G SYSTEM: J GAs J ELECTRIc ,I � <br /> ���7 259-8810 ///��� ' <br /> i DENfOLiT10N �MBINATION i F JILDING MECHANICAL ! ; PLUMBING SIGN <br /> r'"'�„ ON'N@R/l 1Nl.A0DRE55 CITY IIP FlHONE <br /> �� ��l�u��/�rz Ssl� '�G��,��(lr` f/�y�✓;//,� 9�L7v GSr-s97� -- <br /> ^' TEHANi MAi_nDDFE55 CIT ZIP PHONE � <br /> AFCHITECTOROESIGNER MA�LADDRESS CIN ZIP f�HONE <br /> � ���' '. .-�AL C,ONiRACTOR MFIL AODRE55 GTY ZIP FHONE STATE UCENSE A � <br /> � ��. � -�1:CpLGONTRAGTOP MAILAOOflE55 CITv Z�p pHONE STATELIGEIJSEa � <br /> �'��+ <br /> � <br /> �}� _' _ <br /> ' �-':GGONTRACTOR MAn.ADDRESS CIiV ZIP PHONE STAiELICENSEe i <br /> +�'�.�� ' _ f, <br /> . �';1fiAGTPRICEOfWJflN 1 <br /> C�P.�^RI�E WORK AND SOUAFE FGOTAGE INVOLVED f,ONTFCT PF.RSON AND PNONE NO , �I/ G�PF�P� p��' ,�I <br /> / �l <br /> ��u�'�'a'" . Zs L- y�33 � 3Xfr- z�i �v � <br /> � l. O I HEFEBY Cf-il-fIFY THAT I HAVE READ AND 13XAMINED THi+�. �� <br /> .oPoseouseoF ew�oivc APPLICATION AND KNUW THE SAME i0 BE 1���UE AIJD CORRECT. AL�� <br /> PHOVISIONS OF LAWS AND ORDINANCES GOVERNIVG THIS TYPE UI <br /> LEG4LOESCBIPTIONOFPROPERTV�SMOWNBELOWORATfACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN O!�. <br /> l��IAqLI �_ LoW cII NOT. THE GRANTING OF A PEFMIT DOES NOT PFIESUME TO Glv� �I� <br /> �or e�ocK oF AC",NORITY TO VIOLATE OR CANCEL THE PROVISIONS OF Ald'� <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TF,' <br /> - � -- PERFORA9ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TVI! ; <br /> OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR WI dCFI <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r�,-..:-:cei_tnx i o Nun�e�a CONTF TORS LAW 78.27 RCW AND 296200 WAC. � <br /> sooyoo9o, ozv� <br /> COGSiHUGT1011 LOAH LENOEfl.�DDflE55.TEIEPHONE N IAEi R �r �J ��' <br /> ���.��- � �,'' � ���- �-�Y ,'. <br /> PROJECT ADDRES � �2�j s��c�nrun� onr� <br /> � rnvou�vessucss��.�+o - - - <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OF FIXTURc OR ITEM FEC- NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILETj !�.'C-A/HNDLG UNITS-H.P. _�_ <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. ; <br /> LAVATORY(WASH BASiN) i _ UNIT HEATERS-B.T.U. M i <br /> SHOWER CLOTHES DRYERS � <br /> KITGHEN SINK 8 DISP Vf.NTILATION FAN ; <br /> DISHWASHEfl RANGE HOOD � � <br /> LAUNDRY TfiAY ; WATER HEATER <br /> CLOTHES WAS!iER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAW FEAT PUMP � <br /> BACKFLOW PREVENTERS GF,S PIPING <br /> ROOF DRAINS-RAINLEADERS EXMAUST FAN � ' � <br /> SINK!SERVICE-BAR.ETC.) ' _ � <br /> --r- - <br /> , � <br /> — , � <br /> _ — <br /> � _ <br /> SUB TOTAL $ _ 8UB TOTAL S ' <br /> PERMIT $ � PERMIT 5 <br /> TOTAL FEE S TOTAL FEE 5 ' <br /> FOR OFFICE US�ONLY: <br /> FRONTSETBACK AEARSETBACK 310E:TTBACK PLANCHECHNUP.OER FEE HECEIPTtJO. <br /> usFzoNe LOTAREA VACANTsire FEES VALUATION FEE <br /> 7 YES G NO BWLDING J <br /> i�PEOiCJNSi. 1lO.UFSTORIES OCCUPRUGv q00�m1Etun6mu;c — � <br /> cnauo PLUMBING _ � ._ I <br /> 52EOFBLGQ FIRESPRINNLEFSREO'� BASEMENT MECHANICAL � I <br /> i�. YES ❑ NO — <br /> OGCUPANCYIOAD FIPEALARIdREO'D HEIGHTLIMITATION ADDITIONFLPLANCHEf;K i <br /> i <br /> OTH[R ' <br /> FEFSON ` <br /> STATE BUILDING SURCHAfiGE �t7 U <br /> i <br /> INTnKE BY PlANSAPPROYED 0Y CITY OF EVERETT PU�UG WORKS <br /> LOCAL SALES <br /> oATE � TAX COUE IS 3105 TOTAL �9 ;5"d <br /> � <br /> a" <br /> - — �� � „� ;� .�s�,r.�.,, �, , <br /> ��.yy..''�� e�d�BJf'�+�1 "�]�"' ' . .... '. .�. � k 1 �. ,.�n{s. '. <br /> . . , d�t.�ap k, � �,^rr <br /> ::�.�' _�:.- � ��� . :_. �;..�- ''v'}E� ��2'',�:;�: <br /> . ., . i ... _ ;f,� .,- ,.._. .. _ . - `��� .-� ' °` ._= _.'._ _ _ <br /> . ' . ...y .._ k... <br /> , -.:.' ... � M �,,. <br />