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APPLICATI�1 FOl; CONSTRUCT�R� P�RMIT � <br /> TO BE COMPLETED IN 19LACK INK—PLEASE PRINT <br /> LD � � � <br /> BUII.DING DEPARTMENT �1EATING�YS';EM. GAS ❑ELECTRIC ❑__ �� <br /> 259-8810 , <br /> ❑ DEMOUTION C�COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN � <br /> OWNER MAILADDflE55 CITV ZIP PHONE <br /> �1Jfl� Co��dwJ�i. Cr.p �/007 l,.��D�.1� I�J4v 4boa i o��6 - �fbf= �/1�/N .I <br /> TENANT , MAILADDRE 5 CITV ZIP PNONE �' <br /> ARCHITECTORDESIGNER M�ILAODFlESS CITV 2•P PHONE ' <br /> Lr �'/i,> P.o, ao,. �q� Gy ,.,, �oy6 2�6 - �/us- ayl6 <br /> 6ENEN�L fiACTJfi MAIL�UDfiESS CITY 21P PHONE STATELICENSEt L DOCOC+ri <br /> �rj�a G.��d�.�frv �P ��0�7 �'�O.le BodGU 9b0�►� ='-6c- yes= y�y� IS9KN <br /> MECHANICALCONTF'ACTOfl AILADOR� CITY ZI° PMONE STATIiUCENGeN <br /> P/LU�MBINGCONTR/.�TOR MAILADURESS CIN ZIP PHONE STATELICEN'aEN <br /> , C7r'h ��/`n �N/!� /'�M�d�, . <br /> CONT CTPRICEOF K . �. <br /> .52 <br /> DESCRIBE WORK AND SOU�R fOOTA6E INVOLVEO CONTACT PERSON AND PHONE NO. /�� /r//�f //�^���� <br /> U � Y <br /> 1 <br /> C�.f�,.�.� �..� �'.��L �...,'c� ,�.,� <br /> � ,�SO � � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �� PROPOSED USE OF Bl11LDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> _S'�J� [,� ��,,,.I�„ �y,���o, u F'ROVISIONS OF LAWS AND ORDINANf,ES GOVERNING THIS TYPE OF ���. <br /> �- LE(ULOESCRI OFPROPERN(SHOWN ELOWORATfACH OCOPIES� W6RK WILL BE COMPLETED WITH YVHETHER �PECIFIE7 HEREIN OR � <br /> , �_ eW �/1� . NUT. THE GFANTING OF A PERIdIT DOES NOT P�ESUME TO GIVE <br /> � �or e�xK oF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��Q�� ��� � � _ OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> i „ — PERFORMANCE OF CON5fRUCTION.THAT I AM AUTHORIZED BY THE <br /> � , OWNER OF THIS PFOPFRTY TO PERFORM THE WORK FOfi WHICH . <br /> . APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � PARCEL TN(I.D.NUMBER CONTRA CTORS LAW 1827 RCW AND 296.200 WAC. <br /> i CON Ti1U:TIONLOANLENDER,ADDRESS.TELEPHONENUMBER �/�/� /�n G <br />� � 4/ r L X Y f �EaS/�1� / Y.lit� ,�/• / �2 � � <br />' PRO,IECT�DDRESS � srow,r� D�TE <br /> � CITY BUSME55 LIGENSE N0. <br />� iPLUMaINO MECHANICAL � <br /> � N0. TYPE OF FlXTURE ON i�iEM FEE N0. TVPE OF E�UIPMENT FEE <br /> � WATER CLOSET(101LET) � A/G—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; f FORGED AI9 SYSTEMS—B.T.U. M E.A. ' <br /> LAYATORY(WASH BASIN) � UNIT HEATERS--B.LU. M I � <br /> I SHOWER � J CLOTHES DRYERS ' � <br /> �� KITCh!EN SINK h DISP ; 1 VE*1TILHTION FAN � <br /> � t� DISHWASHtR � RANGE HOOD � <br /> ' WATER HEATER ' <br /> � I LAUNDRYTRAY � <br /> � CLOTHES WASHER � WOOD STOVE � _ <br /> � URINAL ' METAL FIR�PLFCE(WOOD BURNING) ' <br /> � DRINKI�JG FOUNTAW � FlFiEPLACE INSERT � <br /> � FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; G:.S PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> �SINK(SERVICE—BAR,ETC.) � �— <br /> ' _T_ <br /> � c ' <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: a - I� <br /> FRONTSETBACK� HEMSE7BACj( Slr U'ETBAC�j( PLAI�CHF�C Nl1MBEfl FEE ,� / „ f PE �PTNO—.7�� <br /> � � / S � U l%.l (% / <br /> USEZONE LOTAREA vncnrrr re FEES VALUATION FEE <br /> � _ �30'f^�i �S ❑ NO BUILDIN.i � � � 'S�i.� <br /> TY OFCONST. NO.OFSTORIES occuP.wcv No.ovowfwNcuNrts � <br /> 'N Z pW� � PLUM3ING OS <br /> :tIZEOFBLDCi. FIRESPBINNLEPSREO'D BASEMENT MECHANICAL 'pti <br /> 2 9 S F � o ❑ res �o ; <br /> CCCUAMICVLOAD FIREALARMREO'D XEIGHTLIMITATION AODIT�ONALPLANCHECK a i`�7 <br /> � O �• i <br /> OTHER (, , O� <br /> REAS'1N <br /> STATE BUILDING SURCHARGE �� <br /> IMAKE BY PIAN���ED BV CITY OF EVERETT PUBLIC WORKS � O i UcJ <br /> LOCALSALES � <br /> OATE 5 2s/93 ThX CODE IS 3105 T� � �- Q I 27 <br />