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APPLICATIC '1 rO�R CONS'TRUCT�`�N PERII�1lT /��� <br /> � <br /> TO BE COMPLETED IN BI.ACK INK—FLEASE PRINT Ey�,� <br /> BUILDING DFPARTMENT � ntATING SYS7EM: ;�GAS ❑ELECTR�^. � _ _� <br /> 259-8610 — -�—' <br /> k DEMOLITIOM ' COMBINATION X BUILDING ' � MECHANICAL ! ; PLUMBING SIGN <br /> OIYNER IAAILAUDRESS --- ' <br /> �n11CLIP��1 Ct dTY 2P hHONE --- <br /> -- 7��oY e:Pk62 5005 v�eNwooD ��vc . _ ,� f-� l i �lZ:�? (2ob� 259- 353 <br /> TEN4:v� MAlIqpDRE55 ` Z�P - � <br /> CITY VHOt1E ' <br /> r� mE n<, r��c,vE <br /> ARCMITECTORDESIGNER A1AI�AD�RESS GTY qp � - � <br /> PHONE <br /> �ok.�vrJ - voS I I U� N,3 8 ST. �"FA—•rtE � '� / <br /> GENER4LLONTRqCTOR MAILqODRESS �F ( ' 0.1n F:(:? C�10� <br /> �IT�' ZIP HONc S7ATE LICENS[♦ —�— <br /> '>I N6U.) Lnr10 p.(� �o � �j:-? E /F2 � TT , WR " F ?OG� ' o p n p <br /> M[GNqNiCAL CONTRACTOR hIqIL qDDRE55 -�` �� Z�� / � -f � 1 � <br /> CI7V ZIP PNONE STATELICENSE� <br /> PIUMBINGCONTRAQOP MAILAODR:SS ��n• ZiP � , <br /> PHONE STAiELICENSE• � <br /> ClnSS OF WORN � <br /> NEW X ADDITION x ALTERATION '�. REPAIR �� � DEMOLiTION �. WOODSTOVE/FRPL INSERT ( ' BUILDING RELOCATION <br /> CONTACT PE�SON ANU PHONE�NOI . <br /> CONTRACTPRiGEOF\YORN } C�D ,(�l:_1 'I' /-� '�� (rClfZY SO�[_TUIv p <br /> �ESCRIBE WOfiN nNy SOOA(iE FOOIAf,E NYOLVEU — � '��� � r�4'� " 1 I O O � <br /> RemuoE�L(325�s5F 1 � nc�uii�„r4 (s49�ss'F) c �� Ir � ol Nmn ( �oE,) ���}5 ^ �� I no <br /> C)tr' L / �9f ..d��1 <br /> r'ROPOSEO USE OF BOILOING <br /> . i HERE6Y CERTIFY THAT I HAVE READ AND EX4MINED THIS <br /> ' E�1C�E F�)'1 i A L APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ILGaL OESLR�PTION OF PHOPERTV�SHOWN BELOW OR qTfAfM FOUR COPIES) PROVISIJNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �o' _ o��K aF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANTING OF ,4 PERMIT DOES NOT PRESUME TO GIVE <br /> SL"c �\'1 '1.a C{-�F. AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW�;EGUTATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TNAT 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 /> CONTRACT R LAW 18.27 RCW AND 296.200 WAC. <br /> �co5 L•�cr�iwooc� nv�r�iuE �vfi�r-.1T `1�tzo� <br /> , X �_ � _ � <br /> Nr+aecT aooaess s�cx.,une <br /> o�rc <br /> CITY OUSINE55 UCENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F!XTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> I WATFR CLOSET(TOILET) � A�C—luHNDLG UNITS—H.P. <br /> I BATHTUO ; � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> _ LAVATORY(WASH BASM) i IT HEATERS—B.T.U. M � <br /> 2 SHOWEH � CL HES URVERS , <br /> ITCHEN SINK 8 DISP VENTI TION FAN <br /> _ DI WASHER RAN�E H p � <br /> IAUN YTRAY — � <br /> — � WATER HEAT <br /> I CLOTHE � ASHER � WOODSTOVE <br /> __ URIN4L METAL FIREPLACE 8 IMNEY <br /> _ DRINKIN�FOU IN ; FIREPLACE INSERT <br /> FLOUR DFAIN � HEAT PUMP <br /> BA�KFLOW PREVENT S ; GAS PIPING � <br /> _ ROOF DRAINS--RAINLEA S � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> — � - �— <br /> � <br /> - � <br /> SUB TOTAL $ ' SUB TOTAL § <br /> PERMIT S � PERMiT g ; <br /> TOTAL FEE $ ' TOTAL FEE 5 <br /> FOROFFICEUSEONLY: U E: '; cL7c�►ZS '� I �zlc.� J6c= /y(�. �5 <br /> bRi)YTSETBACK R[AfiS5T0ALN SIDESETBACK � PLANCHECNNUMBER FE[^ � �J REC �n� <br /> I 1 _ <br /> --Z $ d't� 3C�r�� �� <br /> �� <br /> usEzo IpTAREA W�CANTSITE FEES VALUATION FEE <br /> — �_ I ,�o� O 9UILDWC � Q q -�^ �r <br /> �Y>EGiL0Yi5 ALICI:'AAIE iYPEOFCONSlA�iUAI OCNrep��r NOO�DWELLixGUHi15 `� �L ✓'� ; VU <br /> cppJ� PLUMBING <br /> 'Q=-N — i 2-3 I � <br /> SIZEo�BI.OG NOAFSIORIES BASEh1ENT --�- <br /> 250 Sf PDqU MECHANICAL <br /> 3B"� s < � nooN s ERiSr� - -- <br /> OCCUPAhC"LOAO FiqESPRNKLERSREO'D HEIGHTUTA:iATION ADDITiONALPLANCHECK � f/ ! �.1 <br /> ZSo 5/� fllb.�/ ._ Yu� (/ <br /> nEnSonFonSaRiNKicqs �O L-- SPRINKLER <br /> STATE BUILDING SURCHARGE �SZ1 <br /> It1TAKt BV PLArySAPPROVEDBY CITY OF EVERETT PUBIIC WORKS � <br /> . i nrn� c��cc . . _— <br />