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AIPPI.ICATIG ] �OR CONSTRUCT^)N PERMIT ���� <br />TO BE COMPLETE� IN e3LACK INK—PLEASE PRINT <br />HEATING SYSTEM ❑ GAS CI. ELECTRIC ❑ <br />SUILDING DEPARTMENT � <br />259-8810 <br />DEMOLITION COMBINATION <br />1dAIL AD�REcS <br />� � <br />TENANT <br />GENERAI.CONTRACTOR <br />IAECHANICAL CONTRACTOR <br />IAAIL A�DRE55 <br />MAIL ADuRE55 <br />MAIL AOOflESS <br />PLUMBINGCONTR�CTOR MAILA�DRESS <br />i�� 3 <br />? nss oF� <br />' I NEW i'. ADDITION '�, ' ALTERATION <br />REPAIR <br />�ONTRACT PRICE OF WORh <br />UESCRIBE WQ�1(��lD SOUARE FOOTpGE INVOLVED <br />6�'�'/� �'i <br />PPOPOSE� ly$E O � WG <br />✓�s <br />�EGAL OES RIPTION OF PROPERN (SHOWN 9ELOW OP ATTfCH FOUR GOPIES) <br />LOT BLOCK _ OF __ <br />'RI7 oADDPE`e� C.i(J // IG�// �� �� <br />o� J <br />PLUMBING <br />I <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWC-R <br />KITCHEN SINK B1Y16P <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADI <br />SINK (SFRVICE—BAR, ETC. <br />FOR OFFICE USE ONLY: <br />FqONTSETBACK REAR $ETBFCK <br />USE ZOHE <br />iYPE OF W NiS. AL'.OV/ABLE <br />OCCUPANCYLOAU <br />REASON FOR SPRINKI.ERS <br />SUB TOTAL S <br />PERMIT 5 <br />TOTALFEE S <br />iVPE 7f LONSi ACIUAL <br />NO.OF STORIES <br />FIRE SPRNKLE�S REO'D <br />INTAKEBY I PLANSAPPROVED9Y <br />SIDE SETB�CK <br />VACANT SITE <br />BUILDING <br />CITV <br />pTY <br />CITY <br />CITV <br />CITY <br />CITV <br />FEE <br />MECHANICAL. <br />ZIP PHONE <br />ZIP PHONE <br />ZIP PHONE <br />ZIP PHONE <br />21P PMONE <br />21P PHONE <br />� ?LUMBING <br />STATE UCENSE x <br />STATE LICENSE k <br />STATE LICENSE p <br />SIGN <br />' DEMOLITWN !�. WOODSTOVEiFRPL INSERT . J BUILDING RELOCATION <br />I COMACT PERSON FND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BC TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WI�ETHER SPECIFIED HEREIN OR <br />NOT. THE GRO,NTING OF A PERMIT DOES NOT PREfiUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF A!JY <br />OTHER STATE OR LOC�L LAW REGULATING COi`:STRUCTION OR "fHE <br />PERFORMANCE OF CCNSTRUCTION. THAT I AM AUTIiORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR V/NiCH <br />APPLICATION IS MADE AND I COMPLY WITH THE 'iTATE <br />CONTRACTORS LAW 1�27 RCW AND 296.200 WAC. <br />X l3c° b� / as-i�s <br />SiGNAtURE OAiE <br />CITT BOSMESS IICEN`_E N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />V�VTILATION FAN ' <br />RANGE HOO[i <br />WATER HEATER <br />WOOD STOVE � <br />METAL FIHEPLACE & CHIMNEY <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING ' <br />EXHAUST FAN � � <br />TOTAL $ <br />PLAN CHECK NUMBER I FEE I RECEIPT NO. <br />3y53� <br />BUILDING <br />OLGOP0.11CY NOOiDYIFlliNSpHIiS <br />caow PLUMBING � <br />BASEMENT AIECHANICAL <br />MEIGHTLIMITAPON ADDITiGNAL P�qN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHAFiGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />