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APPLICATIQ ! FOR CONSTRUCT' lN PERMIT � i <br /> TO BE COMPLETED IN BLACK INK—PLEASE ?RINT <br /> BUILDING DEPARTMENT � HEATING SYSTEM: J GAS �ELECTRIC ❑ —� I <br /> 259-8810 <br /> ❑ DEMOLITION ! I COMBINATION I7 BUILDING i I MECHANICAL ❑ PLUMBING �I SIGN I <br /> OWNER M11pIL��DNESS CITY ZIP PHONE <br /> �PI'lG. / (��J��."�"� � �O/7 '.ZIOi�ST �f/1�P� 9b.:v � �i <br /> TENANT MAILAODRESS CITY ZIP PHONE ' <br /> ARCHITECTOflDE51GPoEfl M41L�ODRESS CITY ZIP PHONE <br /> i <br /> L .17�.Z. l�. 3 0o z wa.�,•-•w� G c�z-*- � 9 fr'Zo i � S� �7 3S— <br />' GENERALCONTR�CiUR MAILA�ORESS CITY ZIP PHONE S7ATEUCENSEN <br /> �uLto-. P�,y�,,. �,�„y /7ai-or�,a u;e��L,U Gra.rtL 4frzay 34J/37,L- D LPO<!� i /-f <br /> ' S6 S <br /> MECNANICALCONTRACTOF IdAILADORE55 CITV ZIP pHONE STpTELICENSEz <br /> PLUMBINGCONTRACTOR MNLAU�RF.SS CITV ZIP PHONE STATELICENSEY <br /> i' <br />,` /?ob,i,so� cvv�>/-� 3r3 (��7� <br /> GOIJTRACj]RICE OF N�ORN <br /> !%� �U�� � <br /> OESCRIB WOP.K AND SOl1ARE F00 GE INVOLVEO CONT�CT PERSON AND PIIONE N0. �7 <br /> Nu.✓ �p.....d4.�b.�. .Geu., w,�do..� L�1�G iCi l - 3y7 �378 � <br /> f�.7-=� /«.,,/o, _fi;.�r':.��� .zwG,'/ - a39-3k�/ft _ <br /> i HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PflOPO5E0 USE OF OUILDINu APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> I.��.✓��PY PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDE CRIPTIONOF?ROPERTY(SHOWNBELOWORATTAGHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGPIED HEREIN OR <br /> �ot s�ock S66 oF O/ti�'o� EU°� � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wrS� / / �� ,/ _=�.� -q3 AUTHORITY TO VIOLATE OR CANCEL THE PFlOVISIONS OF ANY <br /> � �,�iy� ��qTi.�l�.f OTHER SD1TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � r rc/5 Sn 4� a�..� APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TFX IA.NUMBER �139/-S 6 6- o�� _o�o�y CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> iizq� - - <br /> �RUCTION IO�N LEN�E .ADDFESS,TELE HONE NUMBEF � <br /> � ,�-�...�' ` � '� ��zy�4 3 <br /> PROJECTADDRESS J scNRiune oeie — <br /> a0i7- �r" sr �iI/+rr 7/ r.irreusrt�Ess�cENSEr�o - <br /> � PLUMBINCa MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C-A/HNDLG UNITS-H.P. <br /> Z BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> y LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. fv1 ; <br /> SHOWER / CLOTHES DRYERS <br /> � y KITCHEN SINK&DISP - ; Z VENTILATION FAN <br /> 2 DISHWASHER Z RAPJGE HOOD <br /> I LAUNDHY TRAY WATER HEATER <br /> CLOTHES Wf,SHER WOOD STOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNMG) <br /> DRINKING FOUNTAIN ; FIRFPLACE INSERT ; <br /> FLOOR DRAiN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR, ETC.) ; � <br /> � , <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE 5 TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> PAONTSFTOACK REAPSETBFGN � 51[JESETB4CN � PLdNCHECHNUTABER FEE � ' � RECEIPTNO.� <br /> � 7 2 <br /> uS�oNe • LOiAREA VAC�NTSIIE FEES VALUATION FEE <br /> G-"/ ❑ YES I. NO BUILDING �SO �� S <br /> iYPEOiCON$L NO.OFSTORIES otCu�A\LV NOOroKfuu+6uNrt5 <br /> _/� I ouP ,Z � <br /> `t PLUMBING ' <br /> i <br /> SIZEOFBLDG. FIRESPRINKLERSREO'D BASEMEHT � � �,�ECHANICAL \� i <br /> X/S"7��G ❑ YES fvFJO <br /> OCCUPANf,V LOAD FlRE�LAFM REO'D MEIGHT LRAITAII�N AODITIONFL PLAN CHECK .y_ <br /> 4 v I 1��� � <br /> OTHER .�— <br /> REASON � <br /> STATEBWLDINGSURCHARGE � i _ <br /> INTAKE BV PlANSAPpRI��PV CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES T <br /> onTe 8 3� TAX CODE IS 3105 rorn� 3 � <br />