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Ai�PLICATIC� FOR CONSTRUCT'lN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: i_J GAS ;]ELECTR�C ❑ <br /> • 259-8810 <br /> I DEMOLITION �. 1 COMBINATION I ! BUILDING ;MECHANICAL PLUMBING � SIGN <br /> OWHER IAAII��DRc55 GTV ZIP FNONE ' <br /> (�Oti17� �1/� <br /> TENANT MAILAODRESS CITV ZIP PHONE <br /> �fCor�77Gz RRNIi= 332 Sw Fu��en- ,cMu Gfv Cv�c-,r 4�a8 siy-o7i2 � <br /> AFCHrtECTOPDE9GNEF MAILADDRE55 �IIY ziP PHONE I <br /> GENEFat CONTRACTOF MnIL AD�FE55 pTY IiP PHONE STqTE LIGENSE e <br />; c�N �,Uc �b�&a�� S�r r 1_1/NNwnon�g 9Ao� 77G ��S &�2y�,eo�7� c,�c ' <br /> MEG�ANICFLCONTqACTOR AIAI�ADDRE55 CITV ilP PHONE SfR7ELICENSE� <br /> PLUTABING CONTRACTOR IAAIL ADDRESS QTV ZIP PHONE STAiE LICENSE• <br /> CONT CT FpiCE OF WOPK <br /> � � 62 <br /> OBSCFIB WG N RND SOIIME FOp1AGE INVOLVE� � �T f,OYTAC7 P[PSON AND PHONE NO u _ ,, � <br /> � ����� <br /> N D f2J � u � 5— N 776� g3S <br />� I � w�-�-S O� BLDC-, i HERFBV CC-RTIFY THAT I HAVE READ AND EXAMIN�D THIS �'� <br /> � � raorosc�use oF euiioirvc APPLICATION AND KNGW THE SAME TO BE TRUE AND CORRECT.ALL I <br /> i% �� O —�C PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br /> �e�n�oescairnor�oFaaoaERrv�/sr+�o—wN�ee�uwoaartncNrv.�ocoPies� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �oTBrt, 9�1�����I oLo�cK� ov �� 0 F P"/��-�.�r NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV �, <br /> , OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFOR�IANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE I <br /> . OWNER OF THI.S PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � . - APPLICATION IS MADE AND I COMPLY' WITH THE STATE <br /> PARG'Ey 1A%I.�.NOC�OER <br />!• �f3`�1�GL7 — G1� —t�o0(o coNr CTORS Ll,W 18.27 RCW AND 296200 WAC. <br /> I� CONSTPVGTIONIOANLENDE1:.l,D�RESS.TELEPHONENUMBER r � <br /> � � � <br /> f , PROJECT ADDRESS sarv,ro ez "• � <br /> �S3/ OL ��,.A�s��«s,����st�,a <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEA CLOSET(TOILET) � A/C—A�HNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) � UNIT HEATEfiS—B.T.U. M <br /> SHOWER � CLOTHESDRVERS � <br /> _ KITCHEN SINK 8 OISP VENTILATION FAN � <br /> I DISHWAEHER RANGE HOOD <br />, , LAUNDRV TRAV � N.'ATER HEATER <br /> � � CLOTHES WASHER WOOD STOVE ; <br />�' � URINAL ' METAL FIREPLACE(WOOD BURNWG) <br />� ORINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DFAIN HFAT PUMP <br /> BACKFLOW PREVENTERS GHS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR. ETG) <br /> � ; <br /> T <br /> SUB TOTAL 5 SU�TOTAL $ <br /> PERMIT $ PERMIT 5 <br /> TOTAL FEE S TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FFONTSEiBAGK REARSETB N // DES)Fj�GK PLANCNE KNUMBER FEE / i/� P[CEIPTNO <br /> �G r `—� � .� � <br /> usEzoNe �oinaea vaenrvisire FEES VALUATION FEE <br /> �� � YES ❑ NO BUILDING �(OZ �_3 , _ <br /> IttPEOFC�N57. NOOFSTORIES oCweeN[r NoorDWtu�N6mu¢ i <br /> 1 �AOp� PLUMBING <br /> t � 52EOFBLDG. FIRESPRINKLERSREO'D BASEMENT MECHANICAL <br />, ' -� VES .—� NO — <br /> iOCCUPANCYLOAD FIR[ALARIdPEQO i HEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> OTH[F <br /> REASON <br /> STATE BUILDING SURCHARGE � <br /> INTAKE BY PLAN APPRWEDOY CITY OF EVERETT PUBLIC WORKS <br /> �M LOCAL SALES <br /> on,e /'�i l 9, � TAX CODE IS 3105 rora� �� 5G <br />�t <br />