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�4PPLICATIO► FOR CONSTRlJCT1..N <br />TO BE �COMPLETED IN BLACK INK—PLEASE PRINT <br />PERMIT � <br />SUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑__ � <br />259-8810 <br />I i DEMOLITION ' COMBINATION BUILDING MECHANICAL i I PLUMBING ' SIGN <br />OWNER MAILAODRE55 CITY 7.IP PHONE <br />�� 6e�cic,�. .-s�-�.i�,1�2 Pv fiox I�og 5�rrie �./,-� ��,i ii C 2 P- !'7 � <br />TENANT p11.�ESS CITV ZIP PHONE <br />ARCMITECTOR OESIGNER MAIL qDDPE55 <br />MAIL <br />an <br />CITY <br />ZIP PHONE <br />PMONE <br />,� io 3 4• <br />i• i8i/ <br />LICENSE p <br />�i�.v� >��O z Z, <br />MECHANICALCONTPACTOR MAILADOHE55 �� �,Lr� �3�LIjY' ZIP PHONE STAiELICENSEM <br />� <br />�Jo���: 2:. t�r� 7Z-.U✓t.d e�/3 Z.. �/� <br />PLLIMBINGCONTRACTOR MFILADDRESS CITV ZIP PNONE STATELICENSLp <br />CLASSOFWORK �-L,w�uT I�"+p2W�:n`.n�T <br />' i NEW '� 1 AUDITION �ALTERATION ' REPAIR �. I DEMOLITION I WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br />� CONTACT PERSON AND PMONE N0. <br />uca�niocw�nnnnoauunntrwin�tinvu�vtu R�,JISi. �-xisnaG <br />ci����c.�act �sru2�. �2.o�rr. nou o.;coa..Twc <br />_ I"11LL�./D 'L /'��61 .tr <br />P�O$tD,USEOF.BLIILDING �"Jv'1��J 3T�u .�.�� L` <br />)C T I hl C� � V <br />v��C�2ia���-c� ��J �;JL,��� �T I�II <br />LEGAL DESCRIPTION OF PPOPERTV �SHOWN BELOW OR ATTACH FOIIR COPIES) <br />LOT �LOCK OF <br />�SP�:� <br />/��/�:/f.�T L1/l/� <br />yoz ,�_ �- <br />PRQIECT ADDRE55 <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />POR OFFICE USE ONLY: <br />FRONTSETBACH REARSETB�CK <br />USE ZONE <br />TYPE OF CONiS.I <br />S2E OF BL�G. <br />OCCUPANCY � <br />REA50� <br />•�F�)/} L.. <br />INTAKE BY <br />l0T APEA <br />iYPE0iL01 <br />FEE <br />SUB TOTAL S ; <br />PERMIT 5 � <br />TOTALFEE 5 <br />SIDE $ETOACK <br />VACANT SITE <br />iUAI oCtUGaNtv x0 ovpwL:iNcurei5 <br />NO. OF STORIES <br />FIqE SPPNKLERS REO'D <br />\( �o <br />l`1Z I�l rT �� 1 GiV <br />PLANS F?PROVED OV <br />HGIGHT LIMITA710N <br />_ i'- {_ i=. -, ,; c'� C :t <br />�t-�l. t i. l� i'� t=. <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />� 2 �/ 97„ <br />varr/� rt <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 GOVC-RNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GfiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CA�JCEL THE PFOVISIONS 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 PROPER�fY TO PERFORM iHE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH TI�E STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �"�7� �� .C����.y. 3�,2 3�12 <br />s�r,Nmm�[ l —�— <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHcS DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECN NL'MBER <br />�n /.3 � <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />TOTAL <br />BUILDING SURCHAqGE <br />WORKS <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTAL FEE 5 �_ <br />33c�. �o <br />FEE FECEIPTNO. <br />3/�SiS (v333�o <br />.:S <br />