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� <br />� 3 APPLICATIC _J FOR C(�1�iSTF�U�i JN PERMIY <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259•8810 <br />I I DEMOLITION I_ 1 COMBINATION I I BUILDING I'� MECHANICpL I_l PLUMBING ! 1 SIGN <br />OWNER M�ILAOORESS CI ZIP PHONE <br />,�V¢�� /�,. �i..n�_���.,.� O� ��io��...,, �.1II nonn� i_�/o_;/��,n <br />MAIL <br />ZIP <br />�Cl�7i_J�. U� ' +, tJ C. � C G�C i% U`J' S GC� ) c O_. c� 7ln (� <br />ARCHITEC.TORDESIGNEB MAILADCRESS � GITV 21P PHONE <br />GENFRALCONiRACTOR MMLADDPESS CITV ZIP PHONE STFTELICENSEN <br />��CC,G�`.i�.i:c�`�u'tCz(�feo.J�G7�G�E-SC��Cuc_��C,`c.��G��.%�oG'/.�?S8~C%�183 SIC7N-SSi-!/'a <br />MECI(fjIGICALCO"lTFACTOR MAILADORE55 CITY 21P PHONE STATELICENSEq <br />PLUMBINGC9!ITfi�CTOR MNLAODRESS CITV ZIP PHONE STATEIICENS[a <br />I NENd f J ADDITION i I ALTERATION <br />--- 1'� Sf�/ "� <br />CON i PaCT PRICE OF WORK <br />OE£CBIGE\'fORKANDSQUAREFOOTA INVOWED <br />�'�G" Cl1lt�2aG/'�QPC�L-t� /r1.se4 <br />FROPOSEO UyE OF BNLDING , _ <br />I..! REPAIR I i DEMULITION I I WOODSTOVEIFRPL INSERT I! BUILDING RELOCATION <br />� CONTACT PERSON AND PHONE NO. <br />LEGAL DliSCFiIPTION OF PFOPER}�' (SHOWN BELOW OR ATTACH FOUR GOPIES) <br />LOT BLOGN `l OF <br />'�oS'�u�3��, .��L �Ju� <br />PLUMBING ( <br />O. TYPE OF FIXTURE OR ITEIA <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY _ _ <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLCW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK �S�FVICE—BAR, ETC.) <br />SUB TOTFL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFI�ICF_ (9SE ONLY: <br />FRONTSF.iBdCH REAFSETBACK <br />U.".�� ,��1 AfiE�A <br />P/PEOFCONTSh^OV1Adlc TYP�F OIIS.A�UAL <br />SIZE OF BLDG. <br />OCCUPANCYLCLC� <br />REASON FOd SPRINKLERS <br />IIIIAKE 9V <br />NO.OF STURIES <br />FIRE SPRNKIERS <br />9Y <br />SIDE SETBACK <br />VACANT SITE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAhiE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OPDINANCES GOVERtJING 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 HEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC'fION. THAT I AM AUTHORIZED BY TH� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITIi THE STATE <br />CONTRAC.TpRS LAW 18.27 RCW .4ND 296200 WAC. <br />� <br />oate <br />:�!(J MECHANICAL _ <br />FEE NO. TYPE OF EQUIPMENT <br />� AIC—NHNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.LI. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />—� RAMGEHOOD <br />—J— — — <br />; WATER HEATER <br />T WOOD STOVE <br />� METAL FIREPLACE & CHIMNEY <br />i FIREPLACE INSERT <br />� HEAT PUfdP <br />� GAS PIPING <br />� EXHAUSTFAN <br />A�0 BUILDING <br />aaraucr uoo�mv[umsuu�s <br />cxour � pLUMBING <br />8n5EMENT MECHANICAL <br />N/E�iGH�7�uMi7AT:ON ADDITIONALPLANCHECK <br />K�"U�E SPRINKLER <br />STATE OUIL�ING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 rorn� <br />FEE <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />PECEIPT N0. <br />N <br />H <br />y <br />% <br />