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APPLICATI(�1 FOR CONSTRUC'f�DN PERMI'T � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION I� COMBINATION I l BUILDING �(MECHANICAL ❑ PLUMBING ❑ SiGN <br />OWNER M�IkADDRE55 CI P_ PHONE <br />TENANT <br />ZI�' � PHONE <br />�Q7�2 � / �7 � <br />ANCNITECTOROESIGNER MAIL/CDDRESS CITY / ZIP / PHONE <br />GENEPALCONTflACTOR MAILA�ORE55 CIN . Z�P • PHONE STATE�ICENSE� <br />MECNMlICALCONTflACTOfl Mni nur+tss <br />c�D��� co, 66ot <br />onivaiur.enumnr.mR AILADDRE55 <br />CITV <br />STATE LICENSE M <br />CUSS OF WORK ' <br />❑ NEW ❑ ADDITION ��QALTERATION I J REPAIR ❑ DEMOLITION I�_ 1 WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br />CONTACT PEfl50N AN� PHONE NO. <br />---...__.. ���4.�`� 2nil r,�t2 I.�TI ftt�.LS?=1J <br />OESCRI�E WORN ANO SOUAPE FOOT�GE INVOLVED <br />?�E-Ra7►� EX15�'�1.�G DUL�WoPJ�. <br />PROPOSED USE OF BIIILDINQ <br />LEGAL DESCflIPTION OF PROPERTY (SHOWN BELOW OR ARACH FOUR COPIES) <br />LOT BLOCK OF <br />PRQIECT ADDPESS <br />`72s�7 �v�RG1�N �n//� <br />PLUMBING <br />N0. TYPE OF FI%TURE OR ITEM <br />VJk; ER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCFIE� SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN ' <br />FLOOR DRAIN <br />BACKFLOW PflEVENTERS _ <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FFONTSETBACK NEAR: <br />USE20NE ��TAR <br />1VPEOFCOHTS.ALIOWABLE TYPEOf <br />SIZEOFBIOG. NO.OF <br />ACIOAL <br />OCCUPANCYLOAO � FIHESPRNKIERSREO'D <br />FOfl <br />INTAHE BY <br />SIDE SFT6ALK <br />b / �' I'1 bZ7 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISION� �F LAWS AND ORDINANCES GOVERNING TIiIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOL!,'. = OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTqUCT10N. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS � 18. 7 RCW AND 296.2U0 WAC. <br />C ry r <br />8 -1 J <br />ycNniu . onrE <br />[IiV 905 WESS OCEIbE NO <br />MECHANICAL <br />N0. TYPE OF EOUIPMEN' <br />A/C—IUHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T,U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />NUMOEF <br />%/�j � <br />SUB <br />FEE $ <br />VACANTSITE FCCJ ����+^'�"'• <br />euaoiNc • � <br />occuonxcr xa orow[ur.icuvns i <br />LPOIIP PLUMBING ' i <br />1 <br />BASEMEM MECHANICAL ' <br />i <br />HEIGHT LIAIITATION AD�ITIONAL PLAN CHECK i <br />i <br />SPRINKLER � <br />-� <br />S7ATE BUILDING SUACHARGE � <br />CITY OF EVERETT PUBLIC WORKS ; <br />LOCAL SALES , <br />TAX CODE IS 3105 TOTAL ; <br />