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APPLICATION. FOR CONSTRUCTI d PERMIT <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> everett HEATI�EMGAS JELECTRIC U — <br /> BUILDING DEPARTMENT <br /> 259-8810 MECHANICAL PLUMBING SIGN <br /> DEMOLITION X COMBINATION XBUILDING — <br /> p7 A ly qE MAIIADDRESS GTV 1iP PSE � 53y-N <br /> b [Ry�7 f it .aok �' Dzon�In Sfxtane p �r19 t�PHONE (V�) Y <br /> N MAIL ADDRESS C 7V <br /> TENANT <br /> 1� Y ,,�CITTY �jZIP PONE �P2-2^il ZZZ ARCHRECT OR DES•IGANER MAE ADDRESS - KIrY/WEIL "I r7I <br /> � <br /> y _ 11 AT ,JQYZI f lam' IIn,nG — 21P PhJNE LICENSE F <br /> MAR ADDRESS CRY <br /> nE <br /> 0 M GENERAL CONTRACTOR T/y J <br /> m y' Trj n>?r L' -i^N 21P PHONE IICCNSE F <br /> CC O MECHANICAL CONTRACTOR MA0.ADDRESS <br /> 0 P" plpgE LICENSE F <br /> PLLAABBIO CONiRALTOiT MAIL ADDPESS <br /> CRY 21P <br /> M <br /> CLASS OF WORN <br /> NEW � ADDITION ALTERATION REPAIR DEMOLITION WOOOSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO <br /> tl CONTRACT PR—Of OF WORK <br /> � <br /> h1 1[Ap OESLR9E WORK ANp 5011ARE EOOTAOE INVOIVEO / QA�/` 4 t JI <br /> C y S lly3 S �E I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUNDn}p,�, pppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S/11��C '^7,nI r�}I d��r� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL DE IPTpN OF PROPERLY ISH BE LOW OR ATTACH FW RcoPIESA- � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT BLOCK <br /> OF •U NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> NV <br /> OTHER STATE OR LOCAL LAW P°GULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION,THA'I AM AUTHORIZED BY THE <br /> OWNER OF TOFOR WHICH <br /> APPLICATIONI IS PROPERTYISANDPRFORM IE COMPLYH WITH KTHE STATE <br /> .200 WAC. <br /> SIGNATURE CONTRACTORS <br /> CONTRACTOR OR AUTHORIZED w� DATE <br /> 30 S 100'4' /TZe <br /> {�1�n PROJECT AODRESB AP`I CANTS CRY B0.III 5110ENSE NO ANp BUSINESS NAME <br /> e PLUMBINGMECHANICAL FEE <br /> NO. TYPE OF FIXTURE OR REM FEE N0. TYPE OF EQUIPMENT <br /> A_C-AMNDLG UNITS-H.P. ' <br /> WATER CLOSET(TOILET) 1S ' <br /> r �I = FOh^.ED AIR SYSTEMS-B.LU. M E.A. <br /> BATHTUB �,-� UNIT HEATERS-B.T.U. M ' <br /> LAVATORY(WASH BASIN) �O, _ / CLOTHES DRYERS <br /> SHOWER I - VENTILATION FAN <br /> KITCHEN SINK 6 DISP _ RANGE HOOD <br /> DISHWASHER ' <br /> r l WATER HEATER <br /> LAUNDRY TRAY ' <br /> CLOTHES WASHER , WOOD <br /> FIREPLACE a CHIMNEY <br /> L� URINAL , FIREPLACE INSERT ' <br /> 1 DRINKING FOUNTAIN _ T <br /> HFAT PUMP <br /> FLOOR DRAIN <br /> BACKFLOW PREVENTERS , GAS PIPING <br /> ROOF DRAINS-RAINLEADERS ! EXHAUST FAN <br /> I I ni iso' 00 <br /> SINK(SERVICE-BAR.ETC.) <br /> �r I <br /> _ SUB TOTAL f ' O <br /> r1r SUBTOTAL f PERMIT f "T' <br /> PERMIT s TOTAL FEE f <br /> TOTAL FEE f <br /> FOR OFFICE USE ONLY: RECEIPT NO <br /> pl CHECF PLUMBER FEE <br /> FRONT SETBACK PEAR 6ETAACK SIDE SETBACK -2 <br /> dV �(J ' VALUATION FEE <br /> AREA VACANT SITE FEES <br /> LOT AR <br /> USE ZONE sz� <br /> Jf. � f"i. BUILDING LT�j L / 'G� <br /> !1 IppMLLIIMU IM�16 T �,.G1;�) � <br /> TYPE acoNrs wpwABLE TnEacasT.Aciuu ^�' / PLUMBING _i+=r=— <br /> 811E OF BLDG NO OF STORIES BASEMENT MECHANICALUU <br /> iol7 r yl O <br /> � CHECK <br /> OCCUPANCY LiIRFSKLERS PEOD HEIGHT LMdd✓N 'l <br /> l <br /> . <br /> OTHER <br /> M1AIA// l <br /> REASON FON SPRINKLERS STATE BUILDING SURCHARGE ' <br /> MTANE BY PIANS APPROVED BY CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> 9 1%� TAX CODE IS 3105 TOTAL <br />