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APPLICATIC-1 FOR CONSTRUCT"1N PERMIT � <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />DEM041TION COMBINATION <br />py,n�Eq IdAILADDRE55 <br />, <br />��.r.,v-c „ JPau?/� hoe <br />, <br />HEATING SYSTEM: J GAS L] ELECTRIC � �� L � <br />BUILDING I i MECHANICAL <br />GTV ZIP PHONE <br />1n7o7 (� s; f� �tinvet�_ <br />i_', pLUMBING <br />�¢ 9B1u S <br />SIGN <br />N 3iy �17 <br />TCT14�iT .. .. MRILADDRE55 LITV ZIP PHONE " � <br />�LE�¢7T �E�N,fR� NororrAz 7Go8 I�vM�wAt�. fW�d-ru3 9��.0/ aS 8� y�1y _ <br />aqCHrtFLTOROES�GNFR MRILA�OPESS CITV IIP PHONE <br />%�w, G a r ciRr c;�r �� i)f s, b M v(o � 7fo a.z-�� s cD'7� <br />GENERM GONTFnLTOR MML AOORESS QiY 21P PMONE ST/TE LIGENSE k <br />� ccrss�-sre K�s,�y 1a�S NE lla s� c�t�o c� 9�is 3 � sy3r <br />1A[CHANIGALGONTRALTOR M�F�I A�ORESS GITv ZIP PHONE STATE UCENSE <br />N�;� <br />PLUMBIN6CONTf1ACTOFl MAI��DDRE55 CITV ZIP PHONE STATELICENSEk <br />N /�}- <br />CONTRRGT PRICE OF WOFiK <br />DESCPIBE W�HK AND SOl1ARE F(XfTFG[ �NVOLV[� <br />�� �=D �enF p►�1 C-�v_ <br />�U�CD�N� - No �ivhV� <br />i'ROPOSW USE OF �UILOING <br />�F.����c. Nosv�rfl2 <br />LEGAL DESGFIPTION OF PROPERTV SHOWN BELOW OR Fi1AGi <br />�pT BLOCK OF <br />PFPGELiR%ID.NUM6ER <br />CONSiRUCTICMIOANLGNDEA.ADDRESS.7ElEPHONE <br />TYPE OF FIXTURE OR <br />CLOSET (TOILET) <br />LAVATORY <br />KITGIiEN SINK 8 DISP <br />DISHWASHEfi <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />UFiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAWIEAC <br />FOR OFFICE USE ONLY: <br />PRONTSETOnC✓. REARSETBRCK <br />US_'ONE <br />irre rn coxst <br />�,� <br />SI.�E OF BLDG <br />?363 <br />O:GUPANCVI <br />/� <br />II�T/KE AV <br />LOT APEA <br />No l'�av�bC <br />GOPIE51 <br />� '// <br />0 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALfEE 5 <br />NO. OF STOFIES <br />/ <br />FIRE SPRINKLERS REOD <br />., � <br />FIRE ALARM REO'0 <br />N� <br />PLANS P�OVEDBV <br />, <br />DATE 5 - - tiv <br />SI�E SETBACK <br />CONTACT PERSON ANU PHONE NO <br />i HEREBV CERTIFV THAT I HAVE REFD AND EXAMINED THIS <br />APPLICATION AND KIJOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINFNCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETrIER SPECIFIED HERE!N OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATWG CONStRI �CTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM C.JTHORIZED 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 78 RCW AND 296.200 Wl�C. <br />,vxi ;rierunr�� nr.t[ <br />CIIVflJ51n1f5511!I�r'.Illi _ <br />N�„ TYPE OF EOUIPMENT � FEE <br />A'C-A HNDLG UNITS-H.P. <br />FOfiCED AIR SYSTEMS-B.T.U. M E.A. <br />l,�NiT HEATERS-B.T.U. M _ <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METALF'REPLACE <br />FIREPLACE INSER" <br />GAS PIPING <br />EXHAUSTFAN <br />PLnNCHECKNUMBER I fEE <br />S <br />$ <br />$ <br />0 <br />VES �� N� BUILDING ���% ����_�C1 <br />LJWIICY N�O�MIFLL�MG1;N�i5 <br />GNW> PLUMBING <br />_ , <br />�SEMENi MECHANIGAL <br />;.-� YES � � NO <br />EIGHTLIMITATION ADOITIONALPLANCHECH ' <br />i <br />OTHER <br />STATE BUILDING SURCHARGE ' � <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCALSALES ; ,— <br />TA% CODE IS 3105 TOTAL 3 2 <br />