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•APPLICATIOI�FOR CONSTRUCTI( N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT I HEATING SYSTEM:XGAS U ELECTRIC U <br /> 259-8810 <br /> f DEMOLITION COMBINATION BUILDING I MECHANICAL I I PLUMBING SIGN <br /> OWNER MAIL ADDRESS CITYD ZIP PHONE <br /> (� S,r7Lwo��,' `gnus /4�!/o L�cI/-'�r%ACD >ov ' env.. : bcjo7 -a3a.3 <br /> TENANT 'TAIL ADDRESS CITY ZIP PHOyNE CP�/'T� <br /> ARCHITECT OR LESIONER MAIL ADDRESS CITY ZIP PHONE <br /> GENERA 60NTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSED <br /> ci.sj C��1�-,_e✓ <br /> MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE 9 <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSES <br /> ('ONTRACT PRICE OF WORK_ Pal 416)9 <br /> ESCRISE WORK AND Sr ARE FOOTA E INVOLVED /�/� _ •^,'q^^^^'•• •�PHONE N9 .µ ? <br /> gzr <br /> 649 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P`gOPOSED USE OF BULDING /� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 07 n21,6 Y^A%Ay j&S^7G[_G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL YSCRIPTION OF PROP (SHOWN BELOW�OORRATTACH <br /> TWO COPIES) WORK WILL BE COMPLE1 ED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT 15 BLOCK OF A-E/ �I7�LI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Qy.�s OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — �,� PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �� / •7 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PA CEL TA%I.D NUMBER CONTRACTORS LAW 11.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS EELEPHONENUMBER L <br /> .Ll.�I,��Y�L6..� 7•aG•9�/ <br /> PROJECT ADDRESS DATE <br /> /, 14 CITYBUSINEFSLKENSENO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A1C-A/HNDLG UNITS-H.P. <br /> BATHTUB ' FO_PCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M i <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DIP ; _L17VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; / WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> _ URINAL ' METAL FIREPLA:E(WOOD BURNING) ! <br /> _ DRINKING FOUNTAIN FIREPLACE INSERT <br /> T <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS i GAS PIPING <br /> ROOF DRAINS—RAINLEAOERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> 7 <br /> SUB TOTAL $ SUB TOTAL S ' <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTZ}� +SETBAGK / REAR SET ACK ESETBACK PLAN CHECK NUMBER FE RECEIPT NO <br /> USE E LOTAREA VACANT SITE FEES VALUATION FEE <br /> _l YES '-I NO BUILDING 1070 :00 <br /> TYPE OF CONSM(MRHMGUNDS <br /> PLUMBING Q0 <br /> SIZE Of BLD q'tr FIRE SPRINKLERS REO BASEMENT i <br /> 3,75/ 3P ,f MECHANICAL <br /> TooSP GnR o ves Nn <br /> OCCUPANCY L D FIRE ALARM REG0 HEIGHT,(.IEALL TJ7 ADDITIONAL PLAN CHECK I <br /> 17 �/J.�c OTHER 0. i Uo <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANS AP?ROVED By CITY OF EVERETT PUBLIC WORKS <br /> J LOCAL SALES <br /> DATE Cj QE� TAX CODE IS 3105 TOTAL 7� <br />