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APPLICATIQ`' FOR CONSTRUCT!'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION C.l COMBINATION �� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILADDRE55 CITV ZIP PHONE � <br /> J �M i�C,Ja-.�tu�l�� s►�'I 2�!`� ,c✓¢.�1. ��rE,�r ���03 •5_/�,�—D9� <br /> TENANT MAILA�ORE55 LITV ZIP PHONE <br /> ARCHITEGTORDESIGNER MAILADDRESS CITY 21P PHONE <br /> RoD s Ne�r�a�r 33w �rr Izs+S �.� �(8i�s 36f-6133 000�a �('I <br /> GEN ALLONTRACTO AILA 5 CITY 21P PH NE STATELICENSEN <br /> � 7�� ) ", �� � � <br /> eCMANICAL CONT R '��l ADDRESS GTV ZIP PHONE. STATE UCEN�s�,N <br /> Vi/1 J�����' <' � 1 f�31�1� <br /> PLUMBINGWNiRACTOfl MAILAUURESS CITY ZIP PMONE STATEUCENSEN <br /> / �� <br /> CONTRFCT PRICE OF WORK <br /> . � � O0� <br /> DE,s CRIBE WOFN AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PH NE N . �� <br /> aDL�� IOa! O �i ' �0 20 -3 /• �/33 � 7c -(,3� <br /> •, ,^ m ,� / o y 379 vre <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PflOPO5EDU5EOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �j6y� �f(p �Cap/J� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SMOWNBELOWORATfACHTWOCOPIES� WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �n��,¢pb NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT��— BLOCK oF AUTHORITY TO VIOLATE OR CANCEL i HE PROVISIONS OF ANY <br /> (�— �� � �c�_�,�-�S !�o /� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> f'i' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ,(�`r�� 000-00 °I'OO�.S OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION �S MADE AND . COMPLY WITH THE STATE <br /> � PN�ATA%I.D.NUMBER �;/ ���-p i/ CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> J,�- /`f <br /> � � CONSTRUC110NLOANLEYDEF,GDDflE55,TELEPHONENUMBER ��� n� � <br /> PROJECTADDRESS sia ua's�""`�"—`�'� o�re <br /> 5 �� 23~� ��� ��S CIiYBU51NESSLICEN5EN0. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN � _ <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ' �VATER HEATER � <br /> :LOTHES WASHER WOOD STOVE ,�_ <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ! <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEA�ERS � EXHAUST FAN ' <br /> S�NK(SERVICE—BAR,ETC.) � � <br /> � ' <br /> � ' <br /> � <br /> _ <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE 5 ' TOTALFEE $ ' _ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAq SETBACK �, n� SIDE SET9ACK � FLAN HECK UMBE FE� OS RECEIPT NO. <br /> 2 I z--5 T° N �7 S 2 <br /> USE ZON- _� LOT qREA �ACANT SITE FEEW VALUATION FEE <br /> � � /� � L YES i�NO BUII.DING C Q3 � ' � <br /> iYPEOFCONSi. NO.OPSTORIES o[cuvcha MoaroWnuNGUNrtS � <br /> cnauv I PLU�dBING � <br /> �� i <br /> SIZE OF BLDG. FIRE SPRINKLERS flE�'D BASEMENT MECHANICAL � <br /> ❑ YES i�0 ' <br /> � <br /> OCCUPANCV LOAD FIRE ALARM REOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> O � � <br /> OTHER � <br /> REASON i�� <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPR �(EDBY CITY OF EVERETT PUBLIC WORKS � <br /> �- LOCAL SALES <br /> � DATE � 5.5 TAX CODE IS 31G5 TOTAL <br />