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APPLICATIC" I FOR CONSTRUCT r-lN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM:NGAS ❑ELECTRIC U <br /> 2598810 y <br /> O DEMOLITION I\ COMBINATION I I BUILDING CI MECHANICAL I1 PLUMBING SIGN <br /> OWNER ��}A"IL ADDRESS n CITY ZIP PHONE <br /> 4P-e ��dh AT11, <br /> ,f CGr� ETL /007 !(yda �o✓ltG l✓Q 9gozr a416=c/bf-- y�y°/ _ EI <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br /> If <br /> GENERAL CONTRACTOR // /MAR ADORES/Do7 q7 D�,CITYe ZIP PHONE 4I-f3�'4' LbOCGG7K/. lA'v <br /> TE 1.CENSE a <br /> L // d CO�JPi C•✓r . o[ �' .Jf 6�1,d�!/ wd 9So2 r AE' <br /> MECHANICAL CONTT/RACTOR MAI ADDRESS CITY ZIP �j PHONE STATE LICENSE <br /> ls.soo/ el J�4�IHPI Oe73-,jQoo <br /> PLUMBING CONTRACTOR / �MyAIL KESS CITY ZIP PHONE STATE LICENSE F <br /> ( �4 P �: ys3 ��0 <br /> CONT ACT <br /> OF WORK R7�� <br /> DESCRIBE WORK AND SODA'n AMOTAGE INVOLVED CONTACT PERSON AND rHONE NO <br /> SSG 227 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDI APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRaCT.ALL <br /> -r/_• �c ,I PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DAB,RIPTION OF PROPERTY IL BELOW OR ATTACH TWOCOPIESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT— — BLOCK OF 4 a/"Ier- �*' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 'L AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> M-I t t o mI AJZ:Nw OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT ION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> • APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> A EL TAX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> C6NSTRUCTION LOAN LENDER.ADDRFS5 Th f 1110.1[1V 0.I11F N <br /> Q_(CAIEAe <br /> PROJECTAD�DRESS( / 1 sr.Nnwe DATE <br /> 2 S / <br /> (: I -1'\ • h )-) � L -I GTV A'ANE55 LCENS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET, 'II A)C—ATHNDLG UNITS—H.P. _ <br /> B47HTUB / ' IT FORCED AIR SYSTEMS—B.T.U. M E.A.' --~ <br /> LAVATORY(WASH BASIN) / _ I UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHES DRYERS i- <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHERRANGE HOOD I <br /> LAUNDRY TRAY i' ; I WATER HEATER i <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL ' I METAL FIREPLACE(WOOD BURNING) <br /> i DRINKING FOUNTAIN 1 FIREPLACE INSERT i <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS 14 GAS PIPING <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN / I <br /> SINK(SERVICE—BAR,ETC.) ; <br /> I <br /> f I <br /> 4 <br /> ( SUB TOTAL S SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> 1 FFONT SETBACK REARSETBA K SIDE S_T A e PLAN CHECK NUMBER FEE PECWTNO <br /> US°ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> Cl YES ❑ NO BUILDING /z3 <br /> rrPEa 1 <br /> NO OF STORIES acAuoa�An Ao aBAELuxc wnc <br /> PLUMBING <br /> I^ liE OF BLDG a N NJ <br /> I — SPRINKLERS REOD BASEMENT EYES I NO MECHANICAL Ao <br /> Y "IOCCUPAEICY �D FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> N <br /> OTHER RA WA) � <br /> PEASON <br /> STATE BUILDING SURCHARGE 41 I <br /> INTAKE BY PLANFROVED BY CITY OF EVERETT PUBLIC WORKS (/J- <br /> /�/� LCCAI.SALES <br /> DATE r.�,r7� • 3 TAX CODE IS 3105 TOTAL 7 ; O <br />