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APPLICATIC 1 FOR CONSTRUCT' 1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ' <br /> BUILDING DEPARTMENT HEATING SYSTEM: GASy ELECTRIC U <br /> 259.8810 <br /> I 1 DEMOLITION ! 1 COMBINATION !'BUILDING I MECHANICAL PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITY ZIP PHONE <br /> �irr�rLruwuoll' 7Xlru•s /4/!1/o �r_,7cl�D°4aovice<v 98vo7 �y�-� s�3 <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAR ADDRESS CITY ZIP PHONE <br /> (,Qh�� <br /> GENERAL CONTRACTOR }� MAIL ADDRESS CITY ZIP PHONE STATE LICENSE A <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CCTV ZIP PHONE STATE LICENSE A <br /> PLUMBING CONTRACTOR MAR ADDRESS CITY ZIP PHONE STATE LICENSE <br /> CONTRACT PRICE OF <br /> It7j yds <br /> DESCRIBE WORK AND ARE FOOTA E IM OLVED - •••^••^^••• ••s PHONE <br /> N� �f+-ul +v� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P OPOSED USE OF BUILDING OO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> Kt44__oqu Alw ze.sm7LC•LtaLLt PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL fISCRIPTIONOFPROP (SHOWN BELOW CATTACH TM COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK OF ` � ! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 7YjGj�ic.(p1,F6(s ,1/ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> T PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> Y//i1 z. A r��• G•Zz'�, OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAgcELPA TAx ID NUID NUMeen APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> coo o CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> P7?lECT�JADDRESS ( - sgxuuRcO 3 DATE <br /> /.5/ O — ,,— •�T '✓ ;RV BJS,NFAS ILL NSL NO —,- - <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) / AC—AMNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> IT LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M ' <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN ' <br /> I <br /> DISHWASHER RANGE HOOD i LAUNDRY TRAY — WATER HEATER ' <br /> CLOTHES WASHER i I WOOD STOVE ; <br /> '1RINAL ' METAL FIREPLACE(WOOD BURNING) )' <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN ' HEAT PUMP I <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS I EXHAUSTFAN I <br /> SINK(SERVICE—BAR,ETC.) <br /> I ; <br /> I , <br /> I <br /> I <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> _ PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE S . <br /> FOR OFFICE USE ONLY: <br /> IRCMTSLTBACK / REAR rETJIACK IDE SETBAC , J/ PLAN CHECK NUMBER FEE RECEIPT NO <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> _ 17"70" ❑ YES ❑ NO r <br /> BUILDING <br /> 7VFF Of CONST NO -t <br /> O STORIES oG:uMVLr NO d UHUW4UNitE � <br /> _ Z—jj ' PLUMBING <br /> SIjE OF BLDG FIRE SPRINKLERS RB00 BASEMENT <br /> _s��R O 1 YES NO MECHANICAL <br /> OCCUPANCY LgAD FIRE ALARM REGO HEIGHT UMI ATKHI ADDITIONAL PLAN CHECK �f Q <br /> AZA / OTHER ( D <br /> REASON 1� <br /> STATE BUILDING SURCHARGE V L� <br /> INTAKE By PLANS APPROVED By CITY OF EVERETT PUBLIC WORKS <br /> ✓�� LOCAL SALES 2� <br /> DATE ��o�ryy! TAX CODE IS 3105 TGTAL <br />