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APPLICATION FOR CONSTRUCTp"1N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC J <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> WNER n MAIL ADDRESS CITY IIP PHO IE <br /> visF ^/�fi�in Sin �� ST Su) ctto3I <br /> TENANT MAIL ADDRESS :ITY ZIP <br /> ECT OR <br /> Y tip <br /> LCjq bINCIGNE �MA�OOREIC'7 V �U /Y''- ��IT�2LL._lL�/�/I� PHONE ` - 9 7 <br /> FIALCONTRACTO MAIL ADDRES�� CITY IP PHpNF STATL LICENSE i <br /> �t>✓�=ADDRESS TY � ► �err _ '� E 7 <br /> MEL NICALCO TRACT R MAIL ADDRESS CITY ZIP P,)NE STATE (CENSE <br /> PLUM' IG C��yy**RACTOR. 1 MAID9�DRESS CITY :IP PHO 4E STATE L CENSE F <br /> 7) AJC N"Fl) -- <br /> 40ry,IACT PRICE OF WORK <br /> l 7 <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONCN/F�R PHONE-� 1 / `1�= <br /> IPFA I la.?q- I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P SEO USE OF BUILDING �() APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> E PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE L DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTAC14 coPIES, WORK WILL RE COMPLETED WITH WHETHER EPECIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOS PRESUME TO GIVE <br /> I <br /> OT BfaK of /�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> YIEIC�F{2S, ��50�P�E/J �� BOG.lD /cfl�S S OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -nom PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> ,iiSCgPr TILE IA�yEciy 90 I/1c�FOF OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MACE AND I COMPLY WITH THE STATE <br /> P TAN I D NUMBER CO{�T RS LAW .27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,A DR-PP TELEPHONENUMBER <br /> P!� ECT ADDR SS . r aNA*ulf R.Tf <br /> c Cis r ITY BU51Nf 5 .ICI NSF N'1 <br /> PLUMBING MECH (CAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPHIENT FEE <br /> WATER CLOSET(TOILET) i ATC-A/HNDLG UNITS-H.P. I <br /> BATHTUB ; FORCED AIR SYSTEMS–D. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS–B.T.U. M <br /> SHOWER I CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP - VENTILATION FAN ; <br /> DISHWASHER ' RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN t FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING r E E <br /> ROOF DRAINS–RAINLEADERS EXHAUST F <br /> SINK(SERVICE–BAR,ETC.) <br /> I <br /> T <br /> _ SUB TOTAL $ SUB TOTAL $ _ <br /> PERMIT $ ' PERMIT $ <br /> TOTAL FEE $ ' TOTAL FEE $ �— <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK / REAR SETBACK / SIDE SRECEIPT NO <br /> ET K PIAN CHECK NUMBER FEE <br /> /�� 1 3za <br /> /0. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> YES i NO BUILDING `aj �/77��Q <br /> TYPE OF CONST :q OF STORIES atuw'xr Nu N fWNUASuAIit / 2 <br /> F 59Qp°j PLUMBING (�✓ I <br /> r <br /> SIZE OF lD0 FIRE SPP PERS RE0D BASEMENT i <br /> tt� sI.. .t. MECHANICAL <br /> S GAA= i7 YES 0 <br /> OCCUPANC <br /> YY LOAD FIRE ALARM REO'D HEIGHT uMrtRNON ADDITIONAL PLAN CHECK <br /> Fv /a J OTHER — <br /> REASON 1 <br /> STATE BUILDING SURCHARGE VO <br /> INTAKE By PLANS APPRD ED By CITY OF EVERETT PUBLIC WORKS <br /> J LOCAL SALES <br /> DATE Z� qy TAX CODE IS 3105 TOTAL A� <br />