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{ � APPLICATIO:� FOR CONSTRI��:TI'`�N PERM17' �✓� <br /> TO BE COMPLETED IN BLACK INK--PLEkSE PflINT <br /> ' BUILDING DEPARTMENT HEATING SY�'TEM: ,-�GAS ❑ELECTRIC ❑_ � <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBINATIO�+I �BUILDING I..I MECHANICAL I :i PLUMBING I_I SIGN <br /> pWNER MAiIADORE�_d qTV ZIP 'HONE � <br /> o-u:;�����zzrC ��ia .Px.��l �F'���`.aoc, i���,e.�,�u.E `����-�� ����-.�.3��3 <br /> TENANT MAILADpRESS CITV ZIP PYONE <br /> pflCMTECTORDE5IGNER MAILADDRE55 CITY �IP rHONE <br /> �G�'�.C- GCJ �`���'L-'�'-/� <br /> G(��NE�RAL CONTRACTOP MAIL ADOflESS CITV ZIP PMONE STATE LICENSE e <br /> ���'CE �l-.) Gl.�`72Lf� CC'GGNl l 2//% MV_,_ <br /> MECHANICALCONTRACTOR MAILADDRE55 CITY 21P PHONE STATEUCFNS[a <br /> \ <br /> PLUMPINGCONTRACTOR MAILADDRESS f,ITV ZT PHONE STATELICE�lSEN <br /> CONTRACT?RICEOF WOflK L r <br /> O�� O.J �.5 I <br /> DESCRIBE WORK AND SOUARE F TAGE I OLVE� C CT PERSOI...ND PII01'F.�JO. <br /> N��v Cbrc.Sstru.c�+�r ?��N3 7c5 /��c,-�..t_ ! - � ��.���,� :� � �.7 <br /> ' �9� �9S <br /> �a ��-� — <br /> �— I HEREBY CERTIFY THAT I HAVE �iEAD ANU EXAMINED THIS <br /> P OGOSEOUSEOFBUILD:N3 �� qPPLICATION AND KNOW THE SAME TO BE TRI!c AND CORRECT.ALL <br /> I ��Q. ; �CULLI I /C.t CGE-62 G<'-- PROVISIONS QF LAWS AND ORDINANCES GO'bERNING THIS TYPE OF <br /> LEGA4 SCRIPTIONOFPRO �SHOWNBELOWORAiTACHTWOCOPIES) NORK`NILL BE COMPLETED WITH WHETH�fl SPEGPIED HEREIN OR <br /> �oT---.-�`•' BLOCK— OF �n��yj��1/I NOT. THE GHAN�'ING OF A PERMIT DOFS NOT f'HESUME TO GIVE <br /> AUTHORITY TO '/IOLATE OR CANCE!. THE PROVISIONS OF P.iJY <br /> � � '��.�'f� �j'�' OTHER STPSE Orl IOCAL LAW flEGULATING CONS?RUCTIOtv Ofl THE <br /> �� PERFORMANCE C�=CONSTRUCTION THAT I AM AUTHORIZED BY THE <br /> �O ' , � `���. � � OWNER OF THIS PROPERTY TO PcRFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I C^NPLY WITH THE STATE <br /> P CELTA%I.O.NUMBER �'-� CONTRAGTORS LAW 18.27 RCW AND 29ti�00 WAC. <br /> l '=0CX1- Q55.-c�c�c�� <br /> CONSTRUCTION LOAN LEkDER,AO'JRE55.TELEPHONE NIIL"'Sq �/ '/�// // <br /> X�' :.GJC-C.[._� Y/�(�s..stL�-.G . � '�3'�� <br /> PROJECTADDRESS SIGNRIDflE � on.e <br /> ,� � -c-�! qry D��.-5ti(,� <br /> .'J'��17"�9w�1FYv W � VL'✓e-�Y�� �:./��� / d �U,J CITY9USiNE55LILEN5EN0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> '.'SR CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P I <br /> d- 6PTk�iU6 ; FORCED AIR SYST�?MS—BS.U. M F A. <br /> �� ' 1VATORY(WASH BASIN) � UNIT HEATERS—B:LJ. M <br /> I SHOWER ' CLOTHES DFYERS <br /> � KITCHEN SINK 8 DISP ; J� VENTILATION FAN ; <br /> DISHWASHER � j RANGE HOOU � <br /> LAUNGRY 1'RAY ; WATER HEATE;3 <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BU�NING) <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � rJ EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> � <br /> ' Q' <br /> ---� <br /> � <br /> SUB TOTAL 5 j� SUB TOTAI $ � <br /> �ERMIT $ � PERMIT $ <br /> TOTAL FEE 5 ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FBONTSETBACK PEARSET9ACK SIDESETBACK PLANCHEC Nt1MBEq FEE AECEIPT . <br /> Z.s' 6A�' o ' �.�'� ��� �� G>��! � 9 3�� <br /> 115EZOYE LOTAFEA VACANTSITE FEES VALUATION FEE <br /> �� Z ❑ YES � N� BUILDING 2ZZ �6� D /D' � <br /> TYPEOFCCN51. NO.OFST IES ?r,UPu;tv xOC�mvElun�;mui5 <br /> 'n� ' 1 � A�� J PLUMBi:JG �� <br /> J <br /> °2E OF BL�G FIRE SPRINKLERS PEO'D BASEMENT MECHANICAL //O � <br /> 3 1�9 SF ��2 p ❑ YES v�.Q NC <br /> OCCUPANCY LOAD FIRE ALARM REO'� HEIGHT LIMITATION ADDITIONAL PLAN CRECK 2 �'D <br /> �(�/�. �J �S / OTHER �/��N / i <br /> REPS— ON� ' /� <br /> , STATE BUILDING SURCHARGE L���{J <br /> INTANE 9Y PLANS APPROVED BY CITY OF EUERETT Pueuc woaKs 2U� <br /> I ,J� LOCALSALES <br /> Dn7E 3 � y TAX CODE IS 310'o TOTAL /3/��j��Q <br /> ____... <br />