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1oe`� APPLIC�ATIf�N FOR C�OI�STRUCT'Ot� PERMI'' �✓� <br />TO BE CUMPLETED IN BLACK INK—PLEASE PRIh i <br />BUILDING DEPARTMENT <br />259-8810 <br />HEATING SYSTEM: I— GPS U ELECTRIC IJ_____ _ J <br />I I DEMOLII'ION I� COMBINAT�ON <br />OWRER MAIL�OORE55 <br />_ , _ . � _ ,_ . <br />MAIL <br />AHCHITEGTORDELIGNER IANLADORE55 <br />I✓BUILDING <br />�/ CITY <br />�C{ .Srl � ,-!. %t%{� <br />CITV <br />CIiV <br />t�Mt�„ANICAL I�'PLUMBING i I SIGN <br />Z:P °1'ONE <br />ZIP <br />IiP PNONE <br />GLVEMLGONTiiACTOP M�ILFOOqESS CITY !IP PIION[ StAT[LICENS[n <br />1� I-Sof�c.c,/c �S,d1_o l( �+;i �cc I?c! 5nuh. �,� %?� ;i .�3�7 RN l�S oG�N11 <br />MECMAIICALCONiR�GiJp M1IAhAU0RE55 CITY ZiP PnONL ST fELIGEN°E� <br />�i-d�� �,,- �s �s na�-t D�. Q�.u��K�`.�., wr� r8�» _ 7s'� G.�� �i�k F Q;�; ;�a �, _'� <br />PWh1�INGGONTNf.CTOR MNL�DOfiFSS GTV ZIP PHONE STATELICENSEY <br />7. . '1. '��-i:,l�.. �rn-�,(r- SG Z.�. .v. ,...�- <br />y 9/� ..�w� --.� 92a9a �>'a-rrri�� � �v�=1-, ?�: /3� <br />CON1eiACiPRICEOFWJRK � <br />0[SCRIBE WORN FND SOUAqC OOL�GE INVOLVED <br />7y�,�- �I-�=�-�-� -� �`-� s�.i't <br />. �� � <br />PROPOSEO�T'OO�l9�N0—�J.. � �. <br />i <br />/ <br />/ �,,,i .(y .%.-. i, ...4.1 � �.t.�' o <br />LF.GAL DE SCRIPTI OF PROPERTV �SH01'�' IO[lOW OP ATTPCM T190 GOPIE51 <br />� <br />ior � oiocK oF � 1�1 _ <br />.S' L, �-- <br />PARCELTI%ID NUMOEri <br />CONSTflUCTION LOAN LEN�EP.. AD�RESS. TELEPMONE NUMpER <br />PROJECT ADDRESS <br />iii�,-i�-�� �ts�� %c ) <br />10. TYPE OF FIXTURE OR ITEM <br />Z WATER CLOSET (TOILET) <br />z BATHTUB <br />a. LAVATORY (WASH BASIN� <br />SHOWEfl <br />� KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNURYTRAY <br />� CLOTHES WASHER <br />URINAL <br />ORINKihlG FOUNTAIN <br />FLOOR DRAIN <br />�ACKFLOW PREVENTERS <br />ROOF DRAINS—R.AINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />FOR OFF'!CE USE ONLY: <br />FRONTSETOACN B@nRSEiBAGK ��F <br />20� /�� <br />USEZUNE �QT��E� <br />IYPE OF LOt157 <br />�—fJ <br />SI2EOF�LDG.� T <br />�p�y 5 <br />416 5{ Ga <br />OCCUPANCYLOAO <br />HEA50� � <br />INTANE 0'I <br />fIRE SPRII.IHLERS REO'� <br />FIRE ALARrld'JOD <br />r�nrus nrPeoveo or <br />JN <br />onTe i� /, , _ /c <br />FEE <br />5 <br />A <br />q <br />e <br />SIDE SETBACK <br />JF /`'� �V Z� Sr <br />VACAN SIiE <br />�ES i=i NO <br />nrnmu.cr r,00rowuuecuwis <br />OASEMENT ��� <br />- �� YES `(/NO <br />h.GIGHT lllAlIATION <br />CITY OF EIIERETT <br />LDCAL SALES <br />fAX CODE IS 3105 <br />CONT�CT PEFSON AN� PMONE NO. <br />-Soh�.-k ���/-04/7 <br />i HEREBY CERTIFY THAT I FIAVE RE.>D AND EXAMINED THIS <br />APPLICATION AND KNOW THE gAME TO dE TRUE �ND CORRECT. ALL <br />PROVISIOIdS OF LAWS ANC ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPiETED WIThI WF'ETF:ER SPECIFIED HEREIN OR <br />NOT. TNE GRANT;NG OF A PeRIvtIT OOE: NOT PRESU�dE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TFIE PFOVISIOPIS OF ANY <br />OTIIER STATE OF LOCAL LAW REGULATiNG CONSTRUCTION OR THE <br />PERFORNANCE GP COYSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER UF THIS PROPERTY TO PERFORM THE WOP.K FOR WHICH <br />APPU:ATION IS MP.DE AND I GOMPIY WITFI THE STAT[ <br />CONTRACTORS LAYJ Ic27 RCW AND 290200 WAC <br />' ?_ '� 9 y <br />$GN�i�[ �� [)AIE <br />GII Y OUS�N[55 � dEt4I t10 <br />MECHAMCAL <br />Jp, TYPE OF ECUIPMENT FEE <br />AiC—AiHNDLG UNITS—H.P. <br />j FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M _�__ <br />! CLOTHGSDHYERS ' <br />� VENTILATION FAi! _T_ <br />FANGEHOOD <br />WATER HFAIER � <br />W G(1�.� ST: NE _.--:— <br />ME1P.L tl'IEPLACE (WOOD BURNING'� <br />— � <br />FIHEP:ACE I�� ;ERT _�_.. <br />HE!'.T FL'?AF�� <br />GAS'IPhVG � <br />� -- <br />�1�SO.�c):HhUST FAM ' — <br />-y��— _ <br />—�—._._--- — � <br />PERMIT <br />TOTALFEE <br />PI�NCM/ECHNUMO[R FEG <br />Ll�n%/nln �_ <br />s� , <br />BUILD'.NG SCJ � 3 Z ^_� 7 Y��.%(. <br />_ i <br />� <br />PLUM9ING ' <br />/� � <br />MECHINICAL D( J � <br />— � <br />ADDITIONAL PLAN CHECK ' <br />I <br />OTHER � <br />STATE BUiLDING SURCHARGE <br />_ / I�� <br />-- /' � � .— <br />PU�LIC V✓ORK$ �� -� � <br />TOTAL I I �i'� � <br />-- � <br />