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APPLICATIOi FOR CAN�TRUCT��N PERMIT e�e'Pt� <br />mceve��men TO BE COMPLE7ED IN INK—PLEASE PRINT � <br />CITY OF y� <br />�� _— ��-iA U-�� Gi r� f • _ _ <br />evere <br />BUILDING DEPARTMENT <br />259-8810 <br />_: DEMOLITION _ <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC U <br />COMBINATION ;' BUILDING MECHANICAL PLUMBING SIGN <br />v rvu � b�n�nuuntoa CIIY 4V <br />-�r / 7 `� c i � ; �� �� _ _ <br />� -��e_>- � <ic� �� %J-� c,�e: <br />TENAtJT MA/IL�ADORESS Cliy IIP <br />,�C-:,CL /l '�C' / c� `L'� <br />ARCHITECTORDESIGNER IdAIL4DORE�55 ��Ty ZIP <br />"v i� <br />µcL,LC- ..[o�(f.,)•' '/ .G�.'c�`-C,oti. _ 7r (/-',a,C. S�I:� <br />GENEfipLCONTRACTOli - MFILA�DRESS 'GTV ZIP <br />� <br />-`irGL�;fc.( ��cc�:��i.Llrh Z� l' / CcL�[�_[ `/Y�'1.0 i <br />MECj1ANICALCONTRALTOR MAILACORE55 CITY . ZIP <br />PLUMBING CONTR�CTOR I.IML ADDFESS CITV ZIP <br />CLASS OF WOBK <br />'.' NEW ' � ADDITION . �� ALTERATION �. REPAIR <br />CONTPACToqICEOFWOFH .�—�� - ? -L"r'�- <br />�ESCPI9E YJOPK ANO SOU�RL FOOTAGE INVOLVED <br />: , . i <br />i / [�,� <br />���:� i.: �=� , {!, /I�f1.� (i/�'.q":�Y�:f � <br />PROPOSED IISE OF BUIII]ING <br />� <br />l��Cc�'��LL• r;a(i—� <br />LEGAL OESCFIPTION OF PROPERiY �SNOWN BELO W OR ATTACH FOIIR COFIES� <br />�or e�ocK oF <br />PLUMBING / <br />NO. TYPE OF FIXTURE OR ITEM <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 PREVEIJTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAI. FFE S <br />FOR OFFICE USE ONLY: <br />FqONiSETBACK REAFSETBICH <br />f_ � ' <br />USE 20NE LOT AFEA <br />C— � <br />IYP[OFWNiS.ALLOYlhOIF. iVPEOFCOHSiACTUAL <br />�— �—N <br />SIZEOFBLOG. NO.OfSTORIES <br />�^RNKLERS REO'D <br />/ y�� <br />REFSON FOR SPRINKLERS <br />INT4H@OY PLANS�PPROVEU�V <br />FEE <br />PNON[ <br />'�:5 `, - .i r.i�. <br />PHONE <br />PHONE <br />i y' G.., :' " <br />PMONE LICENSE/ <br />� ��,,���t AFFo2e� �i�a � <br />PHONE LICENSEe <br />PHONE LICENSE< <br />DEMOLITION �. � W�:ODSTOVEiFRPL INSEHT �. BUILDING HELOCATION <br />IWNTACTP/ERSONANDPNOry[N0. <br />�.F�"�-p.�. :�� J'7.://I '� ��`, i�'L- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CURRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEP.NING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HER�IN 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 CONSTRUCTION OR THE <br />PERi�ORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNES OF THIS PROPERTY TO PFRFORM THE WORK FOR WHIC�i <br />APPLIi;AT10N IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUREOFCUNTRACTOROqAUTHOf:IZEO�GENT DAtL �.�q- ) � <br />'� �% /- <br />X-� 1 � ' -_ ,. <br />�—� tl' , , <br />; ��z- , ,-� .� = ;; '�.��. c � i _ <br />APPUC0.HT5 CI.'Y BUS W ESS UCENSE N0. ANO BUSINE55 NA :'F. <br />MECHANICAI_ <br />�O. TYPE OF EOUIPMEN7 FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AI� S`.'STEMS—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 />WCOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT / ; <br />HEA1"PUMP —�— <br />GAS PIPING % ' <br />EXHAUSTFAN� i <br />SIOE SETdACN PLAN CMECK NUMBER <br />p� 27`�9� <br />VACANT SITE FEES <br />�O BUILDING <br />oai,�a;!v r:oorowEwr:;u•ins <br />� '4 'r �� pLUMBING <br />o SEMENi tdECHANICAL <br />�� <br />nEtGHT u�nirnnoN ADDITIONAL PIAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOflKS <br />LOCAL SALES <br />iAX COOE IS 31�5 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TfITAI FFF S � <br />FEE � HEGEiPTNO <br />�/�.�. � �' , <br />a <br />� <br />�— <br />�9a <br />