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AI�PLICATI��; FOR CONSTRUCT`"`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTR�C ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING I�MECHANICAL ❑ PLUMBING ❑ SIGN <br />AINNEH / MAIL�D�RE55 CITV ZIP PHONE <br />��I�,_rz; Z�z g lv� 27� AvE s. �. r��.� �JA /�2�`s <br />TENANT MAllA0�RE55 CITV ZIP PMOHE <br />f <br />,�,�����E:� I�,n �+wr- r-� 21 Cv�ul�l cvnY cii��,1— A 9,`3 �� <br />ARCHITI:CTOPDESIGNER F7AILADORE55 � CITY IIP PHONE <br />GENERALCONTflACTOR MAILADDflE55 CITV ZIP PHONE STA?ELICENSEN <br />PLUMBING CONTFl�CTOR <br />CONTRACT�ICE OF W00K <br />DESCRIBE W� D SQUAI <br />OF <br />l,7nIL A�ORE55 <br />C <br />MAIL ADDRESS <br />FOOTAGEINVOLYED <br />CITY <br />'� <br />CITv <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW Ofl �TTACH iW0 COPIES) <br />LOT BLOCK OF <br />PARCELTAXID.NUMBEF <br />,�2q�cu� -��2-� <br />CONSTRUCTIONLO/+NIENDER,A00PE55.TELEPN01 <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 OISP <br />DISHWASHER <br />L4UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEPJTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR. ETC.1 <br />FEE <br />SU8 TOTAL $ <br />PERMIT $ <br />TOTAI FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACN <br />USEZONE LOTAREA <br />1YPEOFCONSi NO.OFSTORIES <br />SIZEOFBLDG. FIqESPRINKLERSPEO'D <br />OCCUPANCVLOAD <br />PEASON <br />INTAKE BY <br />PLANSAPPROVEDBY <br />J�'�/�� <br />DATE %�pj���, <br />SIDE SETBFCN <br />0 <br />�Z.I.P� <br />) (. <br />21P <br />CONTACT PEIi50N AND PNONE NO. <br />STATE LICENSE N <br />Et� / 1Ir <br />STATE LICENSE +I <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAIJTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATItJG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORY. FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TFIE STATE <br />CONTRF,K,iOA LAW 18.27 RCW AND 296.20D WAC. <br />S i � <br />v�% � � <br />SIGN�iUflE pAiE <br />CiiY Ol15iNES5 LICENSE N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />Al�A/HNDLG UNITS-H.P. � <br />FORCED AIR SYSTEMS-B.T.U. M E.A. � <br />UNIT HEATERS-B.T.U. M ; <br />CLOTHES DRYERS i <br />VENTILATION FAN ; <br />� RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE ; <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT ; <br />HEAT PUMP <br />GAS PIPING ' <br />EXHAUSTFAN � <br />PLAN CHECK NlllABFR <br />❑ YES ❑ NO BUILOING <br />OCCUGM'CY NOOf�WflliN60111i5 <br />caoua pLUMBING <br />BASEMENT IdECHANICAL <br />❑ YES ❑ NO <br />HEIGMTLIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CO�EIS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />RELEIPT NO. <br />�y <br />d <br />