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APPLIC/1:TIC� FOR CONSTRUCT`�N PERM17' � <br />TO BE COMPLETED IN BLACK INK—PLEASE �RINT <br />BUILDING DEPARTMENT HEATING SYSTEM: r] GAS ❑ ELECTRIC f] <br />259-8810 <br />C' DEMOLITION I_; COMBINATION � I BUILDING �(MECHANICAL I:PLUMBING '=i SIGN <br />OWNER IdAILADDRESS � CITY �ZIPt PHONE <br />Ti(A�l�i' Q.crn ��{l7 C� f'1/cun'�"l�nol%i.iv �c+�it'�"i/�-�p7i,-� <br />n�aa aooaess <br />�r .S',,,� ,r <br />OESIGNER IdAILADORE55 <br />R�OR MML�DOFESS <br />x����a1 <br />7NTqFCTOR M LA�ORESS <br />�N�u y� � <br />�RACTOR IAAILA�DRESS <br />CLASS OF WORK <br />��I NEW L.I ADDITION <br />WORKANOSO�UA/RE <br />��Y+ <br />) USE OF DUILOING <br />CITY <br />CITY <br />ZIP PHONE <br />ZIP PHONE <br />. 9��c�- <br />21P p pp�H�O�NE: <br />�Z oQJ-�• <br />��P PHONE <br />STATE LICENSE N <br />S ATE L� <br />���' <br />STATE LICENSE A <br />ALTERATION '.. �. REPAIR f.I DEMOLITION I.l WOODSTOVE/FRP! INSERT Cl BUILDING RELOCATION <br />') M I CONTA�'iJSS Nf-I�i'4E�Nir41f/ .YAY-7//7 <br />W <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH <br />lOT �IOCH _ OF _ <br />�woa s� �����+ <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET(TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEq <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />FOR OFPICE USE ONLY: <br />USE ZONE <br />TYPEOFCONTS.ALLOWABIE <br />SIZE OF BLDG. <br />OCCUPANCYIOAD <br />REASON FOR SPRINKLERS <br />INTqNE DV <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 3 <br />LOTAqEA <br />TYCE Oi COqST. ACTOAL <br />NO. OF STORIES <br />FIRE SPflNNLERS REO'0 <br />PLANS APPflOVED BY <br />SIOE SETBACK <br />I HEREBY CERTi��Y THAT I HAVE READ AND EXAMINED THIS <br />APPLICAI'ION AND KNOW THE SAME TO 8E 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 WOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM Al.'THORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR AW 18 CW AND 296.200 WAC. <br />x <br />�/2 � <br />si u � E�li�� onre <br />NO. TYPE OF E�UIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES �RYEflS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN � <br />PLAN CHSCK NUMBER � FEE <br />BUILDING <br />OCCUPRNGY AO.OIDWEIlING11NR5 <br />aAouv pLUMBWG � <br />BASEMENi MECHANICAL <br />HEIGHT LIfA1TATI0N AODITIONAL PLAN CHECK <br />SPRINKLEq <br />STATE BUILDING SURCHAP.GE <br />CITY OF EVERETT PUBLIC WORKS � <br />LOCALSALES •— <br />TAX CODE IS 3105 rora� <br />TOTAL FEE $ <br />tly <br />N <br />