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�#PPLICATIC �l FOR CONSTRUCT �N PERMIT ���� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />"�i'� �_ <br />-�, �L �! i - — � <br />� HEATING SYSTEM: '..1 GAS $�ELECTRIC ,� <br />BUILDING DEPARTM�[J�,L� I� <br />259-8810 ��( � � <br />DEMOLITION '' `�COMBINATION BUILDING � MECHANICAL PLUMBING SIGN <br />OWtIER M4ILADDRE55 QiY ZiP PHONE <br />MAiL AOGRESS <br />�S 7 . <br />ZIP PNONE <br />ARCMIiECTORDE5IGNFR MA�LADDRESS GTY ZIP PMONE <br />GEN[RALCOGTR�GTOR MMLADDfiESS CITY ZIP PMONE STATELICENSE� <br />�Jy� G !' <br />ldfGHANICAL CONTPFCTOR MAII A00RE55 pTV 21P PHONE ST�TE LIGENSE Y <br />��( .✓e" <br />PLUM�ING CONTRALTOR MAIL AD�RESS sITV 21P PHONE StATE LIGFNSE � <br />CLASS OF WORK <br />� NEW ADDITION '�ALTERATION �. : REPAIR <br />WhTRACT PFIGE OF WORK <br />20�� ' <br />D; SCfi18E�%WORK'AND SOU�RE FOOTAGE INVOLVEU , � <br />\7-���L�J��Li�� iG�'�..Z�l-�)7 .i�i�.:'1 � <br />PPOPOSED USE OF UUIL�IN <br />L[GnL DESCRIPTION OF P�'.J 'ERTY (SI!OWN BELOW OR ATT�CN FOUR COPIES� <br />�o, i.� BLOCN _ OF � r � <br />i�,x. A�,`fi, ij. y7/ %— o00 -o is�— o_oo � <br />PROJC�CTAD�PE�f%S� �)I'/ �'�. <br />1 � / // <br />PLUMB�NG <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />/ SINK (SERVICE—BAR. ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />RiONTSET�FCK / REARSETBAGK � <br />�' 17 �n <br />� C/ <br />USEZJNG LOTARE� <br />�~/ <br />IVFE OL CON�S. ALLOlVABIE TYPF OF WYS7 ALiOAL <br />�fi . � ii� � / <br />512@ OF 9LDG I NO.OF STOfilES <br />��151�G N� <br />OCCUMNCY LOAD FIRE SPRNKLERS NEO'U <br />Id� <br />I'JiNCCBV PIAN54PPBOV6'1�Y <br />�.) N 3�3 <br />SIOE SET�A� / <br />VACANT SITE <br />DEMOLITION �� WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br />I �ONTACT PERSON AND PHONE NO. <br />I HEREBY CEFi?�FY iHAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO Bc TRUE /1ND CORRECT. �LL <br />PROVISIONS OF LAWS AND OADINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THG GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITY TO VIOLATE OR �ANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICFTION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.;7 RCW AND 296.200 WAC. <br />x/ /." 'lIf/�J�� �'1`���'��.'1;' <br />�. � <br />s��,:,r�,��, o�,E � <br />�� — <br />niv Bu:ir:1 ;S '{INSI NO <br />NO. TYPE OF EOUIPMENT � FEE <br />FORCED AIR SYSTE67S—B.T,U. M E.A. <br />UNIT HEATERS—B.T.U. M � <br />--, <br />CLOTHES DRYERS <br />VENTILATION FAN � <br />—� <br />RANGEHOOD .__. <br />WOOD STOVE <br />METAI FIREPLACE 8 CHIMNEY <br />FIfiEPLACE INSERT � <br />HEAT PUMP ' <br />GAS PIPING � <br />EXHAUSTFAN _'' <br />BUILDING <br />occu�+:cr �mo�oxun�iai:��s — <br />°Q� I PLUId�ING <br />onSEUENT MECHANICAL <br />HtiGr+r tinii ATiotJ � s ADDITiONAL PLAN CHECK <br />/� / <br />/i� SPRINKLER <br />STATE OUIL�ING SUFCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COOEIS 3105 rora� <br />SU8 TOTAL 5 � ; <br />PERMIT 5 � <br />TOTALFEE 5 . <br />i'� <br />