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APPLICATIO. . FOR CONSTRUCTI� N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATI�G SYSTEM: GAS :J ELECTRIC U I <br /> 259-8810 <br /> I � DEMOLITION i i COMBINATION ! 1 BUILDING I ' ECHANICAL I PLUMBING !J SIGN <br /> OWNE MAILFOOflE55 7 CIiY ^ 21P � �l PHOBE '�` �7 <br /> • ���FILA DRE55 �S I�1 l C�� I�ZIP�I/WC.��M�(JJLJ/ � ! VJJ �7U�� <br /> TENANT <br /> ��i��- <br /> �RCMITECTORDESIGNER IdpILA00RE55 CITV 21P PHONE <br /> GENER�M ��710AAN6�,�' GTV ZIP PHONE STATELICENSEa <br /> �� ic�� rici� ��—U�S �—_�/� 1��� <br /> �� �� ,I���� CITV IIP PHONE STRTELICENSEb <br /> MECH� <br /> _ SE�tnE, wa ysie9 <br /> PLUldBINGCONTRACTOR MAILAODRE55 CITY ZIP PMONE STATEUCENSEa <br /> CONTRACT PRICE OF WORN • <br /> Ssa -_ <br /> DESCRIBE WORK AN�SOUARE FOOTAGE INVOLVED CO"�TqCT PEFSON AND PHONE NO. <br /> �vi F - <br /> I�ST r.G /�A✓/�� -As ' cc - <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEOUSEOFBUILDING APPLICATION AND KNOW THE SAME TO RE TflUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE Of � <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORATTpCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRP.NTING OF A PERMIT DOES NOT PRFSUME TO GIVE <br /> �or BIOCK oF AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -- PERFOR6IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEP.TY TO PERFORM THE WORK FOR WHICH <br /> Pnace�rnxio NUMeea APPLICATION IS E AND I PLY N'ITH THE STATE <br /> � O CONTRACTOR . 7 RCW 2 .200 WAC. <br /> CONSTflUCiIONLOANLENDER,ADDRESS,TELEPHONENUMBER / 1 <br /> y � <br /> � PROJECTADDRESS ��s S�GNAID OAIE <br /> Gf—C� citvousinessuCeuscn� <br /> � PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> ' WATER CLOSET(TOILET) � A�D—AiHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—R.T.U. SM E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYERS <br /> KITCfiEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER WOODSTOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> URINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOH DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � , <br /> _ � � <br /> SUB TOTAL $ ; SUB TOTAL 5 ; <br /> PERMIT $ PERMIT $ ' <br /> TOTAL FEE S ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FROM i SETBACK qEAR SETBACK SIDE SEiB�CK PLAN MECI{'NU�.1BE(i FEE RECEIPT NO. <br /> 1�l ( 1 <br /> '1 L <br /> usezoNe LOTAREA VACANTSITE ' FEES VALUATION FEE <br /> -! YES ' N� BUILOING <br /> iVPE0FW1lSi. NO.OFSTORIES at[u�Ar:cr r;0o•o�.vEwuGw�irS i <br /> pSJp� PLUMBING <br /> i <br /> i <br /> SIZEOFBLDG. FIRESPRINKLERSREO'0 BAS91dENT � <br /> � YES -' Np MECHANICAL � <br /> � <br /> OCCIIPANCV LOAD FIPE�LARM REOD NEIGHT LIMITATION ADDIT.IONAL PLAN CHECK <br /> i <br /> OTHER � <br /> RE/+SON � <br /> �— <br /> STATE BUILDING SURCHARGE � <br /> INT�KE�1' PLFNSAPPROVED BV CITY OF EVERETT PUBLIC WORKS ' <br /> LOCAL SALFS —� <br /> OATE TAX COUE IS 3105 TOTAL <br />