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APPLICATIC�� FOR CONSTRUCT.)N PERMIT <br /> TO BE COMPLETED IN BLACK INK�LEASE PpINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: �� GAS ;.1 ELECTRIC ❑ � <br /> 259-8810 <br /> DE�AOLITION COMBINATION BUIL�ING �MIECHANICAL PLUMBING �,N � <br /> OWNEN MARADDRE55 CITY ZIP PNCNE <br /> T/� �,y --7 � ,.L/. /'� <br /> TEN�N--d�-'��� I (�l-I�� �� 1 ���1��7/ I �� �l' �( l � ��,f �( / I��i <br /> MAIIADOFLSS r I GITV ZIP PMONE <br /> U <br /> �RCHITE�TOqDES�GNER MAIL�DDRE55 ��ry ZiP PNONE <br /> .ENERAL CONTqACTOq MAIt ADDRE55 GITV ZIP PMpNE STATE IICENSE t <br /> MECM�NIGALCONTR�CTOB MAIL�ODRESS GT' ZIP PNONE STATELICENSE• <br /> ,��r,nnn�� �%`,r�/�� a��l�> -Y>(��'4 T-'`l� !nn �G��, 77�- 7�U �5��/9!✓/ {l�! �I,RC_. <br /> PLUMBMGCONTRIICTOR 1 MAILpDDpE55 CITV I � 21P PHONE STATELICENSE� <br /> � <br /> GLASS OF WORR <br /> '� NEW � . ADDITION ALTERATION REPAIR DEMOLITION � WOODSTOVE/FRPL INSERT '� ���. BUILDING RELOCATION <br /> / , � CANT�CT PEHSpry AND fNONE NO. ^ <br /> GONTRACT PRICE OF WORK �] � ; .-. " � �—�,�� <br /> DESCRRE WORK�ND Sq1�RE FOOU�E INVOLVED � ' / <br /> PROPOSEDUSEOFBUILDIHG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> — ��_ APPLICATION AND KNOW THE SAME TO BE TRUE AND.ORRECL ALL <br /> LEG�L DESCqIP71pNpF pqOPER1V(SHON.'NBELOW ORpTi�CH FWRCpPIES� PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �oT BLOCK oF WORV'WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN QR <br /> -- NOT, Tli� GRANTfNCa OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOR�TY TO VIOLATE OR CANCEL THE PHOVtSIONS OF ANV <br /> OTHER;iTATE OR LOCAL LAW REGUUTING CONSTRUCTION OH THE <br /> PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERfORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACYORS LAW 18.27 RCW AND 296200 WAC. <br /> FRO.IECTADDRE55 �'"�'�z— ��~— �/��/� � <br /> bGH�iUR /�.l�J^� ' O�iE <br /> li� dr S _. <br /> LiTY BUSMESS I ICFNSE NO <br /> PLUMlNIO � ' I�CM�NICAL <br /> MG. TYPE OF flKitl Oq ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILEn � /UC—/VHNDLG UNITS--H.P. <br /> u BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHESDRYERS , <br /> KITCHEN SINK 6 DISP ' VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRV TRAV ; WA7ER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAI FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLqCE INSERT � <br /> FLOOq DRAIN � HEAT PUMP <br /> BACKFLOW PFcVENTERS ' GAS PIPING <br /> ROOF DRAINS--RAINLEADERS � E%HAUST FAN � � <br /> SINK(SERVICE—BAR,ETG) � <br /> � <br /> � <br /> ; ; <br /> _ SUB TOTAL S SUB TOTAL y � <br />. PERMIT E � PERMIT S ,� <br /> TOTAL FEE S ' TOTAL FEE E � � <br /> FON OFFICE USE ONLY: <br /> ' FHONT SETB�CK RE�R SETBACN SI�E SETBACK PIAN CMECK NpNBEP� FEE AECEIPT NO. <br /> �v7d <br />� USEZONE 107ARE11 VALRNTSITE �ES VALUATION FEE <br /> BUILDING ' <br /> Trrt ot coxT5.nuowAei[ Tvre or coxsr.ncruat orcuonrcr xa a ownuxa ux�rs <br /> i <br /> eaao p�UMBING i <br /> SIZE OF PIDG NO.OF STOR!ES B�SEMEN7 M[CHANICAL t� � � <br /> v <br /> OCGOPANCY LOAD FIRE SPFNKlERS REO'0 HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> SPRINKLER � <br /> REASON FOq SPRINRLERS <br /> STA7E BUIL�ING SURCHAFGE � <br /> INTAKE AV PlANS APPpOVE�BY CITY OF EVERETT PUBLIC WORKS i <br /> LOCAL SALES ' <br /> TAX COUE IS 31D5 ror�� �V � � <br />