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APPLICATIC"� FOR CONSTRUCT`�iN PERMiT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: 0 GAS ❑ ELECTRIG ❑ � <br />BUILDING DEPARTMENT — <br />259-5810 <br />f_1 DEMOLITION ❑ COMBINATION I J BUILDING f� MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER_ � .U�I�ADDRE55 — �r ' ��TY '�P PMUNE <br />MECHANICAL <br />MAIL /•��PESS <br />Z�i.� t <br />MAIL P��RE55 <br />MAIL <br />CONTRACT PRICE OP WORK <br />C/,�/Kn/�vn/ — Ti M <br />DESCPIBE WORK AND SOUAPE FOOTAGE INVOLVED <br />LEGAL �ESCI <br />�._ Z <br />OF BUILDING <br />x�� �Qi'E'_ L- <br />CITY <br />�� �� � <br />cirv <br />�ia'H�.0 L��. � <br />CITV <br />CITV <br />�f'/iQT�'�IiA� S <br />� O PROPERTY �SNOWN BELOW ATTACH TW COPIESI <br />— a�aK 73 oF 4�' <br />�7' �/!/aiie �-,� ��T%�O�<- .: <br />� T�� �� <br />�M�73- /oa z - � � <br />ipry LErypF$ ADDflESS. TEIEPHONE NUM9Efl <br />%V � <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DR�NKING FOUNTAIN <br />FLOOR DRA�N <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />Z�p PHONE <br />T y�3�/ Z.� Z-S io O <br />�I� / S���PHONE �B� --�?L —.7C3 Z� <br />Z�p PHONE STATE UCENSE 11 <br />�,J Lv� �33 ?�-•7�57- �9`f <br />Z�p PHONE STATELICENSE• <br />f%ryE's zso� ,E <br />u. <br />z 5�L-.fid <br />CONTACT PERSON AND PHONE <br />i HEREBY CERTIFY THAT I HAVE FiEAD 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 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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 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 LA 827 RCW AND 296200 WAC. <br />ni �, lv Z <br />xn uaE oer <br />LIiV BUSME55 LICENSE NO <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />AIC—AIHNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.0 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 (WOOD BURNING) ' <br />FIREPLACE INSERT - � <br />HEAT PUMP ' <br />GAS PIPING � <br />EXHAUSTFAN ' <br />PERMIT S � <br />TOTALFEE $ ' TOTAL <br />FOR OFFICE USE ONLY: <br />FPONT SETBACN FEAR SETBACK SIDE SETBACK PLAN CHECK NUMBER � FEE <br />JW <br />lISEZONE LOTAREA VACANTSITE FEES VALUI <br />C YFS G NO gUILDING <br />7VPEOFLONSI NO.OFSTORIES occuvA!.�v n0orowElu4cunrt5 <br />caouv PLUMBING <br />SIZE OF BLDG. FIRE SPRINKIEPS REO'D b;.SEMENT MECHANICAL <br />-u ves � No <br />OCCUPANCY LOAD FIRE ALARM PEO'D HEIGHT LIMITATION <br />ADOITIONAL PLAN CHECK <br />INTAKE BY <br />OTHER <br />STATE BUILD�;:3 SURCHARGE <br />PLANSAPPROVEOBY CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />DATE TAX COUE IS 3105 TOTAL <br />$ <br />$ <br />RELEIPT NO. <br />y <br />� <br />�x <br />no <br />NM <br />Op <br />N <br />� <br />� <br />