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APPLICATIC ] FOR CONSTRUC{�JN PERMli U� <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �i �� <br />BUILDING DEPA <br />259-8810 � <br />❑ DEMOLITION <br />OWNER ' MAILADDRESS CITY Z�p PHONE <br />�,^po7-ZO,i �kiV�ievy 383VS talrs� lomiln (Wa� �� I�o (�m��naCo�v, tl�lls YNL. �83 <br />TEN NT AILA�DRESS CITY ZIP PHOFE <br />Cra�e Financ�al I+�oS-A Evtrctt meU ulz,� EVtXe� q80�g . 513 •�BOU <br />AqCHITECTORDESIGNER MAILAOURE55 ITY Z�o PHONE <br />HEATiNG SYgTEM: U GAS ❑ ELECTRIC I] <br />� /�/J`� P_!'�x.L eG°L Q. �%lP/D/ <br />l] BUILDING � � MECHANICAL ❑ PLUMBIDlG <br />4'Ito • <br />L-1 SIGN <br />GENERALCONTRFCTOR MAILA�DRE55 CITY ZIP PHONE STATELICENSEN <br />MECHANICALCONTPACTOR MFILAUDFESS CITV Zlp PHONE STATELICENSEp <br />ni dt 5' ms 1o1i 5.w• Kl�ckita� W2u S�il� loV 5ea1�t¢ �lSl3�f 4�(a g�5�E UNrt�SL 111oR8 <br />PLUMBINGCONTR OF MAILAODRESS CITV ZIP PHONE STATBLICENSEp <br />CLASS OF WORK <br />CI NEW ❑ ADDITION I..I ALTER4TION x REPAIR C! DEMOLITION 1.7 WOODSTOVE/FRPL INSERT I. 1 BUILDING RELOCATIO�J <br />CONTRACTPf710EOFWORK � T���/O•6o IC,1111TP�5('„Y)S�CjkENo. �5�( 33�0 <br />�ESGFIBE WORK AN� SOU,IRE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PR07ERTV �SMOWN BELOW OR ATTACH FOI1R COPIES) <br />LOT 9LOCK OF <br />PflQ1ECT ADDRESS <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <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-RAINLEADERS <br />FEE <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETIfACN REARSETBACK <br />USE20NE LOTAREA <br />TYPEOFCONTS.AILOWABLE ttPEOFCONSi.ACTOAL <br />SIZEOFBIDG. NO.OFSTORIES <br />OCCUPANCY LOAD FIRE SPRNKLEBS REO'� <br />INTAKEBY I PLANSAPPAOVEDBY <br />SI�E SETBACK <br />VACANTSITE <br />I HEREBY CERTIFY THA'i I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COP.RECT. ALL <br />PROVISIONS OF LAWS AND ORDINA�JCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECI�IED HEREIN OR <br />NOT. THE GRANTING Of A PERNIT DOES NOT PRESIIME TO GIVE <br />AUTHORITY TO VIOLATC OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X �,Q..Q �l.�oc� 3• �� 9l� <br />SIGN�IDPE ��� 1 f,� � OATE <br />v <br />Cli\' BUSMESS LICENSE NO. <br />MECHANICAL <br />N0. TYPE OF EQUIPMENT FEE <br />AIC-A/HNDLG UNITS-H.P. I <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M ; <br />CLOTHES DRYERS � <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 />� <br />EXHAUSTFAN � <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />NUMBEfl I FEE � RECEIPTNO. <br />BUILDING <br />OCCUPANCY NO-0fDWELIINGVNIiS <br />cxour � pLUMBING <br />BASEMEN7 MECHANICAL <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDIN� SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />i <br />ON <br />tl <br />0 <br />,�, <br />� -o- <br />� , -'.:' �i} <br />