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I <br /> _ I <br /> APPLICATIOW FOR CONSTRUCT JN PERMIT VLITPII <br /> y w TO BE COMPLETED IN INK-PLEASE PRINT <br /> CITY OF <br /> M HI eve nett HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> i BUILDING DEPARTMENT <br /> yy 259-8810 <br /> H ❑ DEMOLITION JX COMBINATION } BUILDING 1_1 MECHANICAL i PLUMBING L7 SIGN <br /> �9`R MAR ADDRESS Cltt (�jIP /y1 PIKSONNEEE 7 U <br /> K y TENANT MAR ADDRESS CITY ZIP C—T PHONE <br /> yH ARCHITECT WI DE513NER LIAR. DRESS CRY ZIP PHONE <br /> y " CleCh /�( 7n� lr�i�yG� � ?-rray <br /> O c �/Yl�l/iK a� L/USOA MAIL DRESS CITY ZIP PHONEENSEF <br /> tv <br /> 'I /A �sa�xc ) 7Ru i�099S.f1 <br /> MECHN'IC�p1TMCTOR MAR ADDRESS CITY Zip PHONE LICENSE 0. <br /> G]V PC] <br /> zHH'� Hyl PLUTABI:O CONTRACTOR YA0.AUDRE85 CITY 21P PHONE LICENSE <br /> H q SIAVMRK <br /> gCA 'rNE'W :i ADDITION ❑ ALTERATION ❑ REPAIR Cl DEMOLITION ❑ WOODSTOVE/FRPL INSERT Cl BUILDING RELOCATIO14 <br /> H _ <br /> C'1 CG� to CONTACT PERSON AND PHONE NO. <br /> L�1 CONTRACT PRICE Of WORK <br /> F'3y DOtA <br /> H o In ED <br /> d <br /> PROPOSrOUSEOFBUII a ' r ` I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Ss'/rw& � /L(, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L DESCRIPTKNI OF PRJPERTY(( IOVM BELOW DR TTACN WR COP PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> f(I # / WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> L '-� BLOCK of u NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY i <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTgUCTION 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 COMPL'I WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> X <br /> pROJCCT PUURE SS <br /> APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br /> CPLUMBING MECHANICAL 11 <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE I <br /> ,.2 WATER CLOSET ITOILET) I AIC-A(HNDLG UNITS-H.P. I <br /> �_ BATHTUB — ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> II 1 - LAVATORY AbH BASIN) I UNIT HEATERS—B.T.U. M I <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 6 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> illift CLOTHES WASHER I WOOD STOVE i <br /> URINAL _ ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN _ I FIREPLACE INSERT i <br /> FLOOR D11AIN HEAT PUMP ! <br /> A� BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' �- / ' <br /> ` I <br /> I I <br /> I <br /> I I <br /> ru SUBTOTAL $ SUBTOTAL S ' <br /> PERMIT $ I PERMIT S I <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FO.R OFFICE USE ONLY: <br /> FR I`SEIBACI(♦ REARSETBA1K BOE SETBACK PLAN CHECK NUMBER III: RECEIPT NO. <br /> 1 <br /> USF LONEIOi AREA v.c reITE FEES VALUATION FEE <br /> BUILDING # J i/ <br /> TYPE Of CONTBALLOWMLF TYPE OF CONST ACTUAL aaWxla L9 gOYSIAgIMn <br /> _� ,/ Q PLUMBING <br /> SDFHO'd'BTOf11E6 BASEMENT <br /> 7 , St MECHANICAL 1 �� <br /> J• w �J <br /> OCCUPANCY LOAD FIRE SPRNKLERS HEO O HEONTUMIT ITION ADDITIONAL PLAN CHECK i <br /> A! )v 1 OTHER <br /> I <br /> REASON FOR SPRINKLERS ' <br /> STATE BUILDING SURCHARGE U <br /> INTAKE BY PLANSAPPRDVFDB'I CITY OF EVERETT PUBLIC WORKS - <br /> Jkl 2/? fl LOCAL SAI ES <br /> TAX CODE IS 3105 NUL �� <br />