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APPLIC,ATIG.N! <br />FOR CONSTRUCT.JN <br />PERMIY <br />TO DE <br />COMPLETED IN INK —PLEASE PRINT <br />The E.ergrmn <br />CITY OF <br />everett HEATINGSYSTEM• ❑GAS ❑ELECTRIC ❑ <br />-__ <br />BUILDING DEPARTMENT <br />259-8810 <br />t <br />[; BUILDING ❑MECHANICAL <br />El PLUMBING _. SIGN <br />1 DE OLITI N COMBINATION <br />DE OLITtIN COMBINATI <br />MAIL ADDRESS <br />OWNER /T <br />_ 7 ` ZIP PHONE <br />1 R�li <br />']b <br />( <br />�L /C� <br />' <br />r TENANT MAILADORESS <br />CITY 7JP PHONE <br />- - <br />ARCHITECTORDLSKINER MAIL ADDRESS <br />1 <br />CITY ZIP PHONE <br />G/ELNERAL CON TRACTOR MAIL ADDRESS <br />CITY ZIP PHONE <br />UCENSE0 <br />-1!2Z <br />/. <br />3i9-2y57r <br />I Ib M 7 <br />MECHANICAL CONTRACTOR MA0. ADDRESS <br />CITY ZIP PHONE <br />LICENSE• <br />C�2A�ir7c'iiy 14h <br />q PLUMBINGCONTRACTOR MAILADDRESS <br />CITY ZIP PHONE <br />LICENSE P <br />{jtl <br />CLASS OF WORK - n neuAl mAM h WnnDSTOVEIFRPL INSERT O BUILDING RELOCATION <br />NEWL AUONION •. _: nu cnnl w.. ._.,�. ..... ._.. <br />__...__..._.. <br />CONTACT PERSON AND PHONE NO. <br />_ <br />N)\ <br />CONTRACT PRICE OF WORK V !!V <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />r <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PRD,vseousEOFeunoma <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�r ^ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESORIPT OF PHOPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) <br />OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />/ <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 WAC. <br />ORIZEDff.ENT DATE <br />- <br />SIGNATURE CONTRACTORORAUT <br />�ILIA, 7y `OL�7 A�S <br />PROJECT ADDRESS <br />9�y /JI // �/K �� <br />G ev <br />( /6 <br />/�_��' <br />APPLICANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />FEE <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />AC—A'HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U, M E.A. <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD _ <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />I <br />EXHAUSTFAN <br />SINK (SERVICE —BAR, ETC.) <br />i <br />I <br />' <br />i <br />--i— <br />SUB TOTAL $ <br />i <br />SUBTOTAL $ <br />- <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $1 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK / REAR T�GK SIDE BED K PIANO9/N,-71,1) / FE\lam/ lD - RSCEIPtNO <br />USE 2 - <br />TYPE Of CONIS ALI <br />LOT ARE�AY�// <br />L�(�.0 <br />N <br />BUILDING <br />TYP OT CONSTAOTUAI M- <br />]CUM"LY <br />4P0U' <br />�q U:wtiumm"s <br />fju®rf� <br />PLUMBING <br />MECHANICAL <br />NO.OFSTORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />FIRE SPRNKLERS REDD HEIGHTLMITATKA <br />�(J <br />OTHER <br />STATE BUILDING SURC14ARGE <br />PUBLIC WORKS <br />PUNS APPROVED BYTtTAX <br />9 <br />TY OF EVERETT <br />LOCAL SALES <br />CODE IS 3105 <br />OTAL <br />M. <br />