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�. <br />APRLICATIC"�1 �OR CONSTRUCT'f1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: ,�GAS ❑ ELECTRIC ❑ i <br />259-8810 <br />� DEMOUTION ❑ C�MBINATION D� BUILDING I-7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN.'R ldAILADDflE55 pTV ZIP PMONE <br />i��e� � r�V �� �r�% l-�'�t��� . IN ls SNrpr.d b�.lC � 2lcY'� SE�. l�i�* <br />TENANT MAIL�DDRF$5 CITV ZIP PHONE <br />Cl�sc`.P,PE ��e �. , ct�c.q ..� �e.v..iCs.r _ <br />ANCMITECTORGESIGNER M�IL�D RE55 CITV 21P PHONE <br />GfNE ALCONTRACTOR MAILA�ORE55 <br />l�lCo �,�.'�'2.WS I(n2 <br />M[CHANICALCONTNACTOR MAII.ADDFE55 <br />N�+� • <br />PLUM/9�INGCORTRACTOR MqILA0yDRE�55 <br />' 1 IG � � � •—` � G • l J'�'{ � <br />CONTR�CT PRICE OF WORK <br />1'a.DCk) P� . <br />DESCflNE WORK AND SOIIAflE FOOTAGE INVOIVED <br />A WAh /].aa� �`Q.Kl2] [�� �G <br />NE I 1� k <br />PRO?OSED USE OF BUILDING / <br />�C'� < OPTIC#:� `7'z� <br />LEGAL DESCRIPTION OF PFOPERTV (SHUWN BELOYf OR ATTIGH TWO COPIE51 <br />� LOT BIOCK OF <br />PAFCELTAXI.D%/�IU ER'�}� ,/ q <br />�U� (/--�� �7� � Vc� <br />LONSTRUCTIJN LOAN LENDER, AOORESS, TELEPHONE NUMBEfl <br />1405 '"�4 5� EvF�'r� fl�Acs w <br />PROJECT ADDRESS <br />�TI �� � Q4'203 <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />WATEF CLOSET (TOILET) <br />BATHTUB <br />�j LAVATORY (WASH BASIN) <br />SHOWER <br />SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTI�ES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAL�ERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMI7 S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FPONTSETBACK REARSETOACK <br />� . USE ZONE �OT AREA <br />� - lYPEOFCONSi. NO.OFSTORIES <br />. SIZE O� G. FIRE SPRIN ILERS REO'D <br />23 <br />INTAKE BY <br />� <br />FIRE AlA-P1LA REO'D <br />Iv � <br />��` <br />onTE �n/I <br />SIDE <br />CITV <br />� <br />CITY <br />�IN <br />� <br />� <br />0 <br />ZIP <br />,�+ 1=Zqc <br />ZIP <br />ZIP <br />PMONE <br />PNONE <br />7�171 <br />CONTACT PERSON AND PHUNE H0. <br />STAlS UCENSE N <br />�_C¢ <br />STATE �ICENSE � <br />STPTE LICENSE p <br />3'3� . 245°l-1 • <br />I 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 �E 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 CC�:STRUCTION OR THE <br />PEFlFORMANCE OF CONSTRUCTION. TI1AT I AM AUTHORIZED BY ThE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 19.27 FCW AND 296200 \NAC. <br />X l. ) k,.. .�' c�f �� . l � ��iq3 • <br />SuNAT E �z��p�� �NE <br />CIIY BUSMESS LICF.NSE N0. <br />MECHANICAL _ <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FCRCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. Ht i <br />CLOTHES DRYERS _�__ <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER NEATER ' <br />WOODSTOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />F'IREPLACE INSERT - � <br />HEAT PUMP ' <br />GAS PIPING ' <br />_ ; <br />EXHAUSTFAN � <br />PLAN CHE N NUMBER <br />a�os <br />❑ YES ❑ NO BUILDING <br />pt[IICA':LY NO Of OWFLlIN60pii5 <br />�A�' � i_IUMBING <br />BASEMENT MECHAiIICAL <br />❑ YES X_ NO <br />HEIGHTLIlAITFTION ADDITICNAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHAFGE <br />CITY OF EVERETT pUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3705 I TOTAL <br />SUB TOTAL S <br />PC-RMIT S <br />TOTAL FEE 3 <br />