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APPLICATIOL _ FOR CONSTRUCTI..N <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC O -� <br />259-8810 <br />!! DEMOLITION I I COMBINATION BUILDING I� MECHANICAL I I PLUMBING C? SIGN <br />OWNEfl MAILADDRESS CITY 21P PHONE <br />l�a.�.+ke ��se 73S,t'E /s� Sf s� Sf?/SS <br />TENANT MAILAD�RE55 CITV ZIP PHONE <br />MAIL A�DRESS <br />CITV 21P PMONE <br />G/EN}E.�R�AL�CON�TR�ALT)OR MAI�AODRESS CITY ZIP PMONE STATELICENSEN <br />VW/�l'lV <br />MECHANICALCONTRACTOR MAILA�DHESS CITY ZIP PHONE STATELICENSEK <br />PIUMBINGCONTRACTOR MAILADDRESS <br />PHONE STATELICENSEk <br />I I NEW � ADDITION I 1 ALTERATION I�� REPAIR I. DEMOLITION '� ! WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />CONiACT uPE/RSON AN� /PHONE NO. 7 <br />CONTRACT PRICE OF WOflK / �� � � J �eC /K �( /� i 63 ��s�' <br />DESCBIBE WOFK AND SOUARE FOOTAGE INVOLVED _ . <br />,.�iS� �� f f S-t ic /crf � 6�Jl �- ,� V 1 <br />PROPOSED USE OF BUILOING � <br />LEGA� DESCRIPTION OF PROPERTV �SHOWN BE� OW OR ATTACH FOUR COPIES) <br />LOT BLOCN OF <br />5,�.- ,��-f-f��G,ad .�/� �/�,.� <br />3 8.3 0,��dt /c r s�,�1�,� <br />PR0.IECT ADDRE55 � <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) � <br />BATHTUB ' <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK S DISP ; <br />DISHWASHER <br />LAUNDRVTRAY ' <br />CLOTHES WASHER , <br />URINAL � <br />DRINnING FOUNTAIN ; <br />FLOOR DRAIN � <br />BACKFLOW PAEVENTERS ; <br />Fi00F DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) � <br />SUB TOTAL $ ' � <br />PERMIT $ <br />TOTALFEE $ , <br />FOR OFFICE USE ONLY: <br />FRONT SE�TBjACK REAR SETBACN <br />!_D C� , <br />USE Z0� <br />TYPEOFCONiS.ALLO' <br />SIZE OF BLOG. <br />OCCUPAN LOAD <br />N <br />flEA50NFOR5PRl <br />INTAKE BV <br />LOTAREA <br />3�f; f <br />iYPEOFCONSi. <br />NO. OF STORI <br />SIOE SETBACK <br />VACANTSITE <br />Oaa>a^cvOi�oarowEwrvcwins <br />kP1�� <br />FIfiE SPRNKLERS REO'D <br />PLANSAF�ROVE� <br />'�� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <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 TH�S TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES 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 LAW 18.27 RCW AND 296.200'rYAC. <br />�� <br />x `/— z7_s'z <br />SIGNATUPC pPiE <br />NO. <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 />METAL FIREPLACE 8 CHIMNEY <br />FIREPL4CE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PLAN CMECK NUMBER <br />BUIL�ING <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PLAN CHECK <br />.iPRINKLER <br />STA7E BUILDING SURGHAPGE <br />PUBLIC WORKS <br />TOTAL <br />, (o b � 107� <br />� <br />i <br />T <br />i <br />