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APPLICATION FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> RUILDINC DEPARTMENT HEATING SYSTEM; XGAS ❑ELECTRIC Q <br /> 259.8810 <br /> ❑ DEMOLITION ❑ COMBINATION h(BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> /O'VNER MAIL DDRESS CITY ZIP /Jq PHONE &144 •.p,3_1 <br /> (� /Ega)7 <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER <br /> aa MAAIL_ADIDREbS CITY 21P PHONE <br /> Ll Ny n <br /> GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE F <br /> C r�5 <br /> 07c7XIAl— • COI,GAq)V&i11,T <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE F <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE) <br /> CONTRACT PRICE OF WORK <br /> NC��WORK nom• AREF TAOEI ED �/>pI]ApC3'GEq$p[I/.I��PHQ __ Gy9• £I/SFT <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING - /- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> •/ l PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL C&SCRIPTION OF PROPS (SHOWN BELOW OR ATTACH TWO COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT. ILocK OF ��Li�GaF� '� �/ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> t5 �,v AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> /��U PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> •G (Q Lwl �3 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAXI D NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br /> CONSRUOTIONL A LEN R.ADDRESS,TE PHONE NUMBER ��e�g <br /> 1432 5 I• SNJ 174 Wk 48103 YL)_ hyV� <br /> PROJECT ADDRESS s'D"AT 2.../ JET <br /> _ cm IRUNEFe LCENse Nu <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) I A/C—A/HNDLG UNITS—H.P. I <br /> BATHTUB FORCED AIR SYSTEMS-B.TU. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M ) <br /> I SHOWER / CLOTHES DRYERS —� <br /> I KITCHEN SINK 8 DISP / VENTILATION FAN ; <br /> I DISHWASHER RANGE HOODIf ---r- <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT (,•o <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING C75 <br /> ROOF DRAINS—rIAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) ; <br /> I <br /> I <br /> ) <br /> I I <br /> _ SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ I PERMIT $ I <br /> TOTALFEE $ 1 TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK/ REAR Js- <br /> ��ETBIIt , �. PIAN CHECK NUMBER FEE RECEI�/f�C�)TT� � <br /> J / <br /> USE ZGNi� LOT AREA VACANT,61TE FEES VALUATION FEE <br /> mss• ❑ YES ❑ NO BUILDING <br /> TYPE OF CONST. NO.OF ST(:41ES ica~ x001DMllIKO uxni , <br /> 2 in I I PLUMBING 5 ' <br /> I <br /> SIZE yF BLDqq FIRE SPRINKLERS REGO RASEMENT MECHANICAL <br /> 3136 Sf Y ❑ VES NO -Z410 ; C) <br /> 4�IR J <br /> ADDITIONAL PLAN CHECK <br /> OCCUPANCY LOAD FIRE AlARA1 ASO IIEIOHT�LIMITATION i <br /> FI 'c) 7 / OTHER <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS APPROVED BY CITY OF EVERETT PUBLIC WORKS o : d0 <br /> J1 LOCAL SALES <br /> DATE g��/ 9 TAX CODE IS 3105 TOTAL g� <br />