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APPI�iCATI"� N FOR CI�NSTF�U�''"�ON PERMIT '�� <br />TO BC- COMPLETED IN BLACK INK—PLEASE PRINT �e <br />BUILDING DEPARTMENT �— <br />259-8810 <br />I1 pEMOLlTIOM I i COMBINATION <br />OWNEFl IAAI��ODFiE55 <br />�PGE� �i-,1� 7 15'712 1�1�=' � <br />? M�II AOOHE55 <br />W,�r� rt+JG �07 �� <br />W�L':i1�JG m. <br />AP.CMIIECTOFUE51GNEfl MAILADORE55 <br />GENERAICONTRACTOR MAIL�OORE55 <br />MECHANICALCONTRACIOF A7�IL DOfiE55 <br />Ls.�D�STi�� Cp, CFR 2.c� <br />PLUMBINCCONTRACTOR M ILAO�RESS <br />HEATING SYSTEM: �{GAS ❑ ELECTRIC ❑ <br />I I BUILDING �� MECHANICAL f I PLUMHING <br />arv zir PIIONE <br />sw �-� qa��G 2y� 44�3 <br />/, CITY ZIP(yp.�� P�47{O�IJE' '� <br />W�T �� `--`��-i�cl � "ISJl1J �7J. ^ `,I L <br />CITY ZIP PHONE <br />QTY ZIP PHONE SiAiE LICENSE t <br />ITV ZIP PHONE STATElICE45E1 <br />SW C.IUtiWooD� q80.� 6�-!q(� 'kLoDl�Rc <br />CITV ZIP —� PNONE STATELICENSEa <br />I I SIGN <br />�t <br />CV.SSOF WOHK <br />C I NEW I_I ADDITION �ALTERATION I I FEPAIR I J DEMOLf(ION I I V/OODSTOVElFRPL INSERT I.! BUILDING RELOCATION <br />,^/� � CONiACTPER50NAlIDPHONENO. <br />CONTRACT PHICE OF WORN `� I�`-/ J <br />0[SCR�BEv�p RNp� D gal1ARE FpIl T GE 1�y,,'4 � <br />4EPU1Ct C�EA• S�LI� �7S'FJ'� HF?.T-1'U11P5 WTk C��Fii� <br />Pc�oPO5E0 USE OF BUIIDING <br />P��i,�-I L <br />LEGAL DESC7IPTION OF PROPERTV (SHOWN DElG1 <br />LOT BLOCK OF <br />ATiACH FOUR COPIES) <br />PHOJEF AGOwJ ��rr7I�jXJ`�' ` <br />7 _ <br />PLUMBING <br />�O. TYpE OF PIXTURE O�i ITEM <br />KlTI'�HIN SINK P. DISP <br />OISHWASHEfi <br />LIUNURYi�RAY <br />C,LOTHI:.S'NASHER <br />URINv,I. <br />DRINKI�;u FOUNTAIN <br />FLOOR DRAIN <br />BACKFI.OW PREVENTERS <br />FOH OFFICE USE ONLY: <br />FflONTSETBRCN REAFiSETB�l.K <br />TYPE OF fAN75. ALLOWABLE <br />SIZE OF BLDG. <br />OCCUPANCVLOAU <br />i1E�SON FOR SPNNKLEi <br />SUB TOTAL $ <br />PERMIT $ <br />TOTA! FEF S <br />7YPE OF COIIST. RG10FL <br />NO.OF STOfiIES <br />FIFE SPRNKLE175 REO'0 <br />PUNS <br />� <br />FEE <br />SIDE SE7BACN <br />_6 �0-1�68 <br />� 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 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 REGULATING CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT�R L 182 RCW AND 296.200 WAC. <br />x �� �; 5/%J <br />SIGNniI11VE OAtE <br />N0. TYPE OF E�UIPMENT <br />AIC—A/HNDLG UNITS—H.P. <br />fORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEAS <br />VENTILP710N FAN <br />RANGE 1100D <br />WATER H[ATER <br />WOOD STOVE <br />MFTAL F�REPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING _ <br />FXHAUSTFAN <br />PLANCHECKNL'MBER � FEE <br />BUILDING - <br />OCN0INGY NO Of�1VFLLIHGUXlf6 � <br />GNWP p�UMBING � <br />BASEA7ENT MECHANICAL <br />HEIGHTLIMI7A7ION AODIiANALPIANCHECK <br />SPHINKLER <br />STATE BUILOING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LLL'i.L SALES <br />TAX !,'ODE IS 3105 TOTAL <br />PERMIT $ <br />TOTAI. FFF $ <br />� <br />� <br />