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APPLICATIC ! FOR CONSTRtjGT )N PEI�MIT �f <br />TO BE COMPLETED IN BLACK INK—PLEASE PI�INT ��� <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATIOt� BUILDING xMECHANiCAL �PLUMBING SIGN <br />OWNER lAAIL4DOR[SS GrtY ZiP PHfJKE <br />�Q.�.D �-Y_�U.Ocx�+ !R I� h�L�u � t��P•��' `i8 205 3S3 - SU "1 � <br />NnNT UAILADDRE55 Cliv ZIP PNONE <br />nRCNITELTORDE51f,HEP MlILADDRESS CITY TiP PM011E <br />G[NCRnLCONifi4Cf0� l.fAILA0DRE55 CITY ZIP PHONE STAiELiC[NSEv <br />e�a.o v� cr�t�z.,�c �gn� ��� W LyNuc�won _ 7��3c _��.. -ov��� c=����i�c�__ <br />6'�[CHAW�;AiCOtliRACiOR 6NiLPODRES:. CRV ZIP FHONE SIDi[LiCEL'SEe <br />PLUGEliNGC�NTPACTOR MRtLFD�RE55 piY ZIP PIIONE STATELICENSEs <br />CON�RACT PRiCE OF IVOPK <br />� j�0O.00 <br />DESCRIBE WORK ��ND SOUAfiF FOOTAGE INVOIVED <br />�I�1r'lAtsATIOn.> oG C.r�c R)ILIJ�t��y� <br />anoaoseo use oF ouaoinc <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW GR ATTACH TWO COPIE51 <br />LOT— BLOCN OF <br />P4RCELTA%I.D.NUlAB[R <br />�: � � i+uCr iom �onN �er�oea. <br />tJO. <br />TELEPHONE NIIM�ER <br />TYPE OF FI%TURE OR f <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY �WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA!N <br />FLOOR DRAIN <br />BACKFLOW PP,EVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ET0.) <br />FOR OFFICE USE ONLY: <br />�itJ'iiSEt6ACK PEARS[TOACK <br />u`.LION[ <br />r �. f:r �Otl$L <br />'F Cf'BLDG <br />::'..;(. uPANCY LOAD <br />N <br />�.�.'..i [3Y <br />SU9 TOTAL 5 <br />PERMI? 5 <br />TOTALFEE 3 <br />q0. OF STORIES <br />FlRE SPFINKLERSREOD <br />PLANSFPPROVEOCY <br />;,,,r� <br />FEE <br />CONTFCT PE�ISON Ak0 PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAM1IINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED H[FEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OP. :ANCEL TH[ PROVISIONS OF �NV <br />OTHER STATE OR'_OCAL LAW REGVLATING CONSTRUCTION OR THE <br />PERFURAIANCE GF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER CF THIS PROPEflTY TO PERFORM THE WGRK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW tII.D Fi�W AND 296200 WAC. <br />� �a-_` —. T� � <br />..:.-,�lnu:;',r DaiC <br />P rv [L5.p15: ��C11..:r 1:0 <br />MECHANICAL <br />N0. TVPE OF EOUIPMENT <br />A�C—ArHNDLG UNITS—H.P. <br />J FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. �A <br />CIOTHESDRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAfJ <br />SiDESET6ACH PL�NCHECKNU/�'OEH 6EE <br />lLD � <br />VACANT SITE FEE$ <br />�'_'� YES -:� NO pUILDING <br />WCNANtv ry00iDNiLLIIdC.�15 — — ' <br />�A�`P PLUTA9ING <br />BnSEUENT MECHANICAL <br />��'�� VES G NO --- <br />HEIGHTLIldITATION �DDfTIUNALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PJ�LIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAL <br />L� <br />SUBTOTAL 5 ''�;G <br />PERMIT S � <br />TOTAL FcE S 'b 'O <br />RECE6'T Y.O <br />VALUATION FEE <br />AM <br />Y <br />a <br />