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�iP�LICATiO. �'�1� CU�dST�id9CT[ �N PERMl�' <br />`�\ TO BE COMPI_ETED IN BLACK INK—PLEASE PRINT � <br />��r <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS J ELECTRIC iJ <br />259-8810 <br />DEMOLITION COM8INATION BUILDING MECHANICAL PLUMBING x SIGN <br />owr�en r.un.nooa=_ss cirr zi� rHor�=_ <br />�� t�OL_r �tr.IA�IC� 7 al � �c�� � �J�a,t_ re-z ���ze�.si/,ar �i�o� <br />TEN�NT ldNLAD�RESS <br />CITY 21P PHONE <br />nHGHIiECTOR�ESIGNE(i l.1AI�_ADDRE55 Q7Y ZIP PHONE <br />—���L�'lL�o��. � R' � �,�.1��.�=��\�L�. C33--�Z'f-4�2_�L'S txfcs��c�'r+tz��Rv <br />G[TJER4LCO�ITRACTOR 61AI_A�DR[55 � �IiV 21P PHONE STATELICENSEa <br />IdEGH�NICALCONTR�CTOR R1AIL�DDqESS CIiY ZIP PHOtIE STATELICENSEa <br />CONTRACTOP lAAILADDRE55 <br />CLASS OF WORK <br />k"NEW . � A�DITION ' � ALTERATION <br />COHTRACiANCEOFWORK �� <br />DESCRIBE W ORN AND SOUARE FOOTAGE <br />PROPOSED lISL OF <br />�ot <br />�'��OJECT AODRESS <br />PPOPERTY �SHOWN BELOY� OR <br />BLOGK Of _ <br />�Z <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHN/ASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />_ DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADE <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE S <br />CITY ZIP PMONE STATELICENSEa <br />REPAIR DEMOLITION . WOODSTOVEIFRPL INSERT ' BUILDING RELOCATION <br />I CONTACTPERSONANDPMONENO. <br />� CT. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �Py <br />coPiesi PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THiS TYPE OF e <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HC-REIN OR v <br />NOT. THE GRAf�TING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIOPIS OF ANY <br />OTHER STATE OR LOC�'. LAW REGULATING CONSTRUCTION OR THE <br />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COh7PLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />FOfI OFFICE USE ONLY: <br />FRO;!'�SETBACK flEl�RSEiplCK S�OESETBAGK <br />—� 'Ar �,A�r <br />❑SF]bNE LOTAqEA �'ACANTSIiE <br />az <br />IIPECFL7tli5.ALL01YA9LC iYPE0fC0�I5IACIpAL mcurzy�v upOFpWHW:autuu <br />c,a i> <br />4IZL OF BLDG. <br />GCCUPANCYLO�� <br />fiGA50N FOR SPIi�NNLERS <br />C:II�KE BV <br />NO.OFS?ORI95 � DASEIdENT <br />FIFESPPIINLERSREO'D � HEIGMTLPdITAtiON <br />°1' CITY OF EVERETT <br />LOCAL SALES <br />� M TAX CODE IS 3105 <br />sc:�nrune <br />TYPE OF EOUIPMEN' <br />A/C—lvHNDLG IJNITS—HP. <br />FORCED AIR SYSTEMS—B.TU. <br />UNIT HEATERS—B.T.U. M <br />CIOTHESDRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HGAT PUMP <br />GAS PIPING <br />BUILDING <br />PLUId�ING <br />IAECHANICnL <br />AD�ITIONAL PLAN CHECK <br />SPFINNLER <br />STATE F3UILDING SUFCHARGE <br />PU�LIC WOFK$ <br />TOTAL <br />f[E <br />onre <br />M E.A. <br />SU6 TOTAL <br />PERMIT <br />FEE <br />