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ppPLICATIC'1 FOR CONSTRUCT'lN P�RMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM• ❑GAS ❑ELcCTRIC ❑ � <br /> BUILDING DEPARTMEN�' <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION i 1 BUILDING f 1 MECHANICAL �i PLUMBING i SIGN <br /> MAILA�DPESS CITY �.p Z�P PHONE <br /> Ou'N�NER i y�l'�J �Si tiG�Y <br /> �1ARN��' 7��. .STiu�&otn/ /•tt`C NA,; �27'AuE. f•,snRt <br /> MAIL AOORE55 CRY (Z���F TPHONE �n <br /> TENANT IX�iP�� pJ°�, �'J••�'�GJ� <br /> (�aF6 J�caae� LnKE l/oI'� ��"�"asl6 � -- ' <br /> APCHITECT Ofl OESIGNEF MAIL AOOR&+S <br /> CITV ZiP PMONE <br /> GENERPLCONTRAC��MSI�S�RESS CITV ZIP PHONE STATELICENSEY <br /> IMSI(;"• 7.�,H <br /> � � ��T� Z�p PNONE SiATELICENSE> <br /> MEChIANiCAL�T,�A�� � <br /> PLUMBINGCONTRACTOR MAILADDHESS <br /> CIiV 21P PHONE STATE��CENSEK <br /> CONTRACT PFIGE JF WORH <br /> �" �000 •'y - <br /> CESCRIBE WORN AND SOUAPE FOOTAGE INVOLVED <br /> CONTACT PERSON ANC�PHOYE NO. <br /> �v+'�cac ' S - - �,, s�.ar R. �ALs...A a9o -8aoa <br /> �✓� �1��. � ��„_�,�y I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> eaoPpSED USE OF BUILOING APPLICATION NND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � r • 0 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �aL— WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALUESCPIPTIONOFPROPEflTY1SMOWNBELOWOPATiACHTWOCOPIES� NOT. THE GRANTING OF A PERMIT OCES NOT PRESUME TO GIVE <br /> LOT— BLOCK� OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS UF ANY <br /> —� – L� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �'-- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOAIZED BY THE <br /> pWNER OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br /> qpPLICATION IS MADE AND I COMPLY WI�H THE STATE <br /> PARCEI.TA%IA.NUMBEP CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOA�!LEN�ER.ADDRESS.TELePHONE NUMBER \, /�� �_ s/�/yy _ <br /> Y " 0 tE <br /> S�GNFTUR <br /> PROJECT ADDRESS �QY BUSME55 LILENSE NO <br /> I/O/�/ 14�/OUE F MECHANICAL <br /> � PLUMBING FEE <br /> NO. TYPE OF FO(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT <br /> WATER CLOSET(TOILET) � AIC--NHNDLG UNITS—H.P. ' <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � <br /> BATHTUB � UNIT HEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) - CLOTHES DRYERS � — <br /> � <br /> SHOWER � VENTILATION FAN � ' — <br /> KITCHEN SINK 8 DISP RANGE HOOD � <br /> DISHWASHER � WqTERHEA'fEF <br /> LAUNf1RY TRAY � WpOD STOVE � <br /> CLOTHES WASHER , METAL FIREPLACE(WOOD BURNING) ' <br /> � <br /> URINAL � FIREPLACE INSERT _ — <br /> DRINI:ING FOUNTAIN � HEAT PUMP � — <br /> FLOOR DRAIN � GAS PIPING — . <br /> BACKFLOW PREVENTERS � EXHAUSTFAN .�— <br /> ROOF DRAINS—RAINLEADERP, <br /> � <br /> SINK(SERVICE—BA'r'.,ETC.) � <br /> � <br /> � <br /> � � <br /> SU9TOTAL $ � _ <br /> SUBTOTAL $ � —�M�T� $ <br /> PERMIT 5 ' TOTALFEE � <br /> TOTAL FEE $ <br /> FOR OFFICE USE ONLY: F�E RECEIPt NO. <br /> SIDE SETBACK PLANCHECKNUMBER � l /�� <br /> FRONT SE-- �7EAR SETBA N I� I, �/�/� �% ��J, �/.�_+ I V'� � � <br /> �y � FEE <br /> I.OT AREA VACANT SITE <br /> — FEES VALUATION <br /> USE�NE � — / � — <br /> ^ ❑ YES ❑ Nr gUIL�ING <br /> i <br /> NO.OFSTORIES OctUveNtr NaA�V�vfluNGUNuS � <br /> rvPEOFCONSt. Gaouv pLUMBING � <br /> FIRESPRINKLERSREO'D BASEMENT MECHANICAL � <br /> size oF e�oc.� ❑ YES ❑ NO ' <br /> HEIGMTLIMITPTION ADDITIONALPLANCHECK � <br /> OCNPnNC�i OAD FIRE AIARM REO'D i <br /> OTHER <br /> l� <br /> REASON STATE BUILDING SURCHARGE <br /> i <br /> INTANE B PLAtiS APPROVED BY CITY OF EVERETT Pl1BLIC WORKS � 1� <br /> �� LOCAL SALES <br /> DATE �rG <br /> TAX CO�E IS 3105 TOTAL <br />