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L6T7) <br />APPILICATIONIN FOR CONSTRUCTimON PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: QrGA: J ELECTRIC U . <br />BUILDING DEPARTMENT -- - - - -- <br />259.8810 <br />-i DEMOLITION I 1 COMBINATION BUILDING MECHANICAL 1 PLUMBING i SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />AlJeR2N di e l(5 AP_& / ALE. 9Ro77 - aoG �- 88y3-008Z <br />TENANT MAIL ADDRESS CRY ZIP PHONE Ma�i's 949- X/,is(c <br />ARCHITECT OR DESIGNER MAIL ADDRESS _ ,. CITY ZIP PHONE _ (. !!! /A <br />NoR� a hgS ?do/ /RI' s.�. lyl"ma 78037 ?s� <br />PLUMBING TRACTOR MAIL AO SCITY PHONE STATE LICI"NSE I <br />i/T.-i '.7/ L2 -- Gc'2.L9O9 <br />CONTRACT PRICE OF WGRK <br />DESCRIBE SOUARINVOLVED FOOTAGE <br />CONTACT PERSON AND PHONE NO <br />.WORKJJJAN[ <br />g41L <br />[ T <br />— <br />r15E'mEN`!PT <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />Si /e rn L I <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LE KJN <br />9lJ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />T.— BLOCK - cF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />�ilLi <br />PARCEL TAY I D NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />�n�irlerT4Al AA.AT�etM-C <br />SCSS-S/ <br />'6/7- <br />PROJECT ADDRESS StC(,(,� <br />S�NATML °`'`L <br />CHr euswess lK[ns[rn <br />// �� <br />.z <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C-AIHNDLG UNITS-H.P, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />[ <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />) <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />311 Inn <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />) <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />_ <br />SINK (SERVICE -BAR, ETC.) <br />_ <br />i0 <br />SUB TOTAL <br />S <br />) <br />SUB TOTAL $ <br />' <br />PERMIT <br />PERMIT $ <br />TOTAL FEE <br />_i <br />$ <br />TOTAL FEE $ <br />FRONT SET CK <br />REAR SET � CK <br />SIDEjr <br />PLAN CHECK NUMBER <br />FEE <br />3 <br />RECEIPT NO <br />9.3�5 <br />USE ZONE ' <br />LOT AREA <br />BD(El <br />03 <br />VACANT BITE <br />YES ❑ NO <br />VALUATION <br />FEE <br />1UILDINO 3s,(V C� <br />PLUMBING <br />MECHANICAL <br />D v <br />' <br />- -- I <br />TM OF CONST. <br />SIZESIZE OF BLOG.'b ` <br />NO OF STORIES <br />RIRE SPRINKLERS REOD <br />attuMACr NIa Lac MRI <br />BASEMENT <br />n YES It *No <br />T ' <br />ADDITIONAL FUN CHECK <br />OCCUPANCVLOAD <br />FIRE ALARM REDD <br />d <br />HE T LIMITATION <br />, <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />PUNS APPRO D BY <br />f/ <br />DATE 9 93 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />(J <br />