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APP�.�CQ�� ^TL FOR CQIVSTRl1C1 _A!� PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�HEATING SYSTEM� ' GAS ❑ ELECTR 1 <br />BUILDING DEPARTMENT — • U IC J _ <br />259-8610 <br />� 1 DEMOLITION I=1 COMBINATION <br />o�'a+Er� I/� MAILAO�RESS <br />� u c� <br />._..ctSC 2 y/P.�� I , iSvo�l� <br />TENANr �,�nn annacss <br />,.;1(:HIIECT Oq <br />P W IdBING <br />CONiPACT PRICE OF WORK <br />DESCRIBE NORK ANO SOUAi <br />ldNLA��RESS <br />220 �-3 <br />V s �1 <br />CI BUILDING <br />cnr <br />i�(�� 360 <br />CItV <br />G6I F�.se�-: <br />cm � <br />GIiV <br />L=-.{,-h �_ �- _ <br />LEGnL OESCFIPTION OF PqOPERTV �SH01YN BELOW OR ARACH TWO COPIES� <br />LOT BLOCK OF <br />I�aRCEl1A%ID.NUh1�ER <br />CONSTRUCTIONLOnNIENDER.A0DRE55.TELEPHONENU1dBER <br />�', �% � �•rQVC1Vf'1 <br />PLIIMBIN�— <br />NO. T'!PE OF FIX' <br />WATER CLOSET (TOI <br />F:ATHTUB <br />LA\'ATORY (WASH 6A <br />SHUNER <br />KITCHEN SINK & DISf <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FPOIIiSETBALN FEARSETB4CK <br />USEZONE IOTAREA <br />�YPi Ci C01lSi NO.OF STORIES <br />5¢[ OF BLOQ FIRE SPPINKIEPS REa'0 <br />GCCUPAIJCVLOAO �IREAI.AFl.IPE�➢ <br />Rf.n50r1 <br />Il1iGk[ GY <br />PL�NS <br />o�re <br />LITY <br />'0�S . <br />CITV <br />FEE <br />NICAL IJ PLUMBING <br />rrione <br />� 5.�. -#3°� � <br />F'HOIJE <br />�� �' �ic�n • E-Z <br />PHOVE <br />L1 SIGN <br />1.t�0. G <br />C� e�'� �Q� <br />PNONE � <br />PHONE STFTELICENSEe <br />Ph�NE STATE LICENSE a <br />,I�� �(f5o3Z `Sl �67 <br />PHONE SiFTELICENSEt <br />� M���l�F I I S 5G� <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE A�lD CORHECT. ALL <br />PROVISIONS O� LAWS AND ORDINANCES GOVERNING THIS'fYPE OF <br />WORK WILL BE COMPLETED WITH WN�THER SPECIFIED H�REIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR Cl.NCEL THE PROVISIONS OF ANY <br />OTHER 51"AT[ OR LOCAL LAW RE6ULATING CONfTRUCTION OR THE <br />PERFORMAIvCE OF CONSTFUCTION. THAT I AM AUTHORI2ED BY THE <br />OW�JER OF THIS PROPERTY TO PERFORM THE WURK FOR WHICH <br />APPUCATiON IS MADE AND I COMPLY WITH THE STATE <br />CONTF;ACTORS LAW 7827 RCW AND 296.200 bVAC. <br />i � <br />�-2 Z��/� <br />SoN< r ��� . /� OAiC <br />� ��� <br />C�(v0U5lh[SSlCO3C1.0 Tl <br />MECHANICAL <br />PIO. � TYPE OF EOUIPMENT FEE <br />AiC—AiHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UDJIT HEATERS—B.T.U. M <br />CLO�-HESDRYERS � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE ; <br />ME'.AL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT ' <br />HEAT PUMP <br />GAS PIPING . <br />SI�ESETBACY. PLANCNECKNU!.IP.Fy'1; FEE <br />-i'r' , <br />vncnNi sirE FEES <br />L! YES ❑ NO BUILDING <br />atGur�,y�r n0 ofoMuiNr,u'nts <br />r��cu= pWPdBIN� <br />oA5E1dENi MFCHANICAL <br />C' YES �. ; NO <br />HEIGNT LII.IITATI01! ADDITIONAL PLAN CHECK <br />O711ER_ <br />STATE �WLDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORHS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />FECEIPi N0. <br />�X <br />O <br />�M <br />Yu <br />X <br />�y <br />N <br />