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. : �4i�PLICATIO►[ F4►� COIdSTRUCTII ,� PERMIT � <br /> • TO BE COMPLETED IN BLACK INK—PLEASE nRINT <br /> BUILCING DEPARTMENT HE:A'L� �G F.YSTEM: �GAS ❑ELECTRIC ❑_ <br /> --- --.. � <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION �BUILDING ❑ MECHANICAL CJ PLUMDING ❑ SIGh <br /> OWNER MAILADURE55 CITY ZIP pHONE <br /> �ITLr.h�n.,Nr�+7nr�s.L /5�/0 G�!� / �'!7�"'�G� /.3e,GC•¢,vw_ 9b'Gc�7 !r�/�-,�3�� 3 <br /> TENANT MAILADDRESS CITY 21P PHON[ <br /> AflCHITECTORDE:�GNER MFILAODRE55 CITV ZIP PHONE <br /> � aJ �JG�Yc.e-!" <br /> �G ERRL CONTPACTOR MAIL A��FESS CITY ZIP PHONE STATE LICENSE a <br /> G «,S vL✓`7'LC�l� �'C'GGNi l 2//: /Yl�% <br /> MECHANICALCONTpACTOR UqILAODRESS CITY ZIP PHONE cTATELIpENSE> <br /> PLUMBING CONTRACTOR MRIL ADDRESS CITY ZIP PHONE STFTE LICENSE a <br /> CONTRACT PRICE OF WORK <br /> c��3�� aa-Lo <br /> �ESCRIBEWORKANDSOUAREF TA EINVOLVEO C�t�CTPEFSONANOPHONEN 0. <br /> tVltiJ �Oh�f�'Gc.L�O-1? �+�.'Lc'� � (y � � L/CLn.��L-I LL.-iact�.�� "F _' �/7� <br /> :� l..Z �,� 9l� <br /> // �/��� <br /> . i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �P OPOSED USE OF 9UILOING p APPLICATION AND KNOW THE SAME TO BE TRUE AND CCRRECT.ALL <br /> "�CLlyLj I /C-�G. � �2 GC� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA4 5%RIPTIONOFPRO �SHOWNBEIOWORariac����e� // NOTTHELGRANTIONG OF ADPERMIT'DOES NOT PRIESUMEEROEIP�pE <br /> 1'.; <br /> LOT BL(KY OF �U" <br /> � AUTHORITI' TO VIOLATE OF. CP.NCEL THE PROV�SIONS OF AtJY <br /> `���%t/c..LCbj1�'�, bl l��. �,"`2.'� OTHER STATE OR LOCAL LAW!?EGULATING i.ONSTRUCTION OR THE <br /> - q �7– /� ERFORMANCE OF CONSTRUC":ION.THAT I AM AUTHORIZED 3Y THE <br /> �G'GK ��- / /��CL�7 C.- JoZ ' ��NNER OF THIS PROPERTY '.0 PERFOAM THE WORK FOR W��IICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE SlA?E <br /> P CEL TPX I.D.NUTABER CONTRACTORS LAW 1827 RCW AND 2962P0 WAC. <br /> ia -oc.�- � i -or� � <br /> CONSTRIICTIONLOANLENDER.AODRESS.TELEPHONENUMEER ,/ <br /> x�.�«.'`� ���..,_�.�. .� -7- .3.cj`t <br /> PROJECTADDRESS / O'' ��/" / (� S�GNATUPEO��h� o.,e -- <br /> O� � �'!�` Y�{/ G��rLi� ( f �� CITYBUSME554CGNSENO <br /> PLUMBI � MECHANICAL , <br /> � N0. L TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> R CLOSET(TOILET) /// � NC–AIHNDLG UNITS–H.P. <br /> lj BATHTUB /�/ ; � FORCED AIR SYSTEMS–B.LU. M E.A. <br /> "f LAVATOHY(WASH BASIN) � UNIT HE/,�tRS–B.T.U. M ; <br /> I SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> DISHWASHER � � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER V:OODSTOVE <br /> URINA� ; !;iETAL FIREPLACE(WOOD BURNING) <br /> ORINKING FOUNTAIN ; FIREPLACE INSERT ; � <br /> FLOOR DRAIN � � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS–RAINLEADERS i EXHAUST FAN / <br /> SINK(SERVICE–BAR,ETC.) ; � <br /> _. i__ <br /> — ' �� <br /> i <br /> i <br /> �-- <br /> SUB TOTAL $ Q , SUB TOTAL $ <br /> PER611T $ � PERMIT 5 ; <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOP OFFICE USE ONLY: <br /> FRONTSETBACK � REARSEiBAC� O SIOES-'°ACy �/ PLANCHECKN Me�n �nD• US R�CEnIPTjJC�,7 (J <br /> �V 3ry o c; `-, �l_�7 � <br /> usezoNe LOTAREA VRCANTSITE FEES VALUATION FEE <br /> /e �� � ❑ YES L NO BUILDING � � <br /> ttPEOFf.ONST. NO.OFSTOJi �5 , acuvextx xoormvnuNGuxns �{ <br /> _/ �' rj"°�3 / PLUMBING �(��J-�' <br /> i <br /> SRE OF BLDG FIRE SPRMKLERS RE00 8;SEMENT LIECHANICAL � <br /> 3�1? SF G�R D �l YES ��NO //� <br /> OCCUPANCYLOAD FIREALANMREO'D NE13F.T�IMITATION ADOITIONALPLANCHECK ��� <br /> `7 J J OT:1ER �A�Q ' <br /> REASON — <br /> S�ATE 6UILDIN�SURCHARGE O <br /> ,INTAKE 9Y PIANS�PPROVED BV CITY OF EVERETi PUBLIC WORKS <br /> �J I�' LOCALSALES 2�� <br /> oAre3 /�,� ei3 TAXCODEIS3105 Ta7A� � ��g�Q� <br />