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APPLICATIa_J rOR CONSTRUCT. )N <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />PERMIT OL-scl3C <br />BUILDING DEPARTMENT ` HEATING SYSTEM: 4GAS ❑ ELECTRIC ❑ _ <br />259-881[1 <br />CI DEMOLITION COMBINATION i BUII.DIHG MECHANICAL ,PLUMBING i SIGN <br />owN WnADGREss cm � �>— PHONE <br />CITY <br />TEl4W, t^ WIADDNE55 CItY SIPPIgNE <br />i 1 I FN <br />AMFIRRECTONCESgNEq Wn m D ADORESS GP PHONE <br />nI� <br />GENEIULCMRRAC,'�O^R MAOORESS Cm DP PIA]NE STATE LICENSE♦ <br />�' W <br />MEGMN'CAL CONiIIAGIgi W4AO]I1E55 CRY DP PNIXIE STATE LICENSE/ <br />n.ln.1 ?�I1L7 -W11 Fug- %a-b) rbr41Ljv%to3P1. <br />( I ADDITION CI ALTERATION i.J REPAIR 1 1 DEMOLITION 1. I WOCIDSTOVE/FRPLWSERT fI BUILDING RELOCATION <br />LOMgAOt PRKE OP VAJRIt <br />C ACT PERSdI AND PHONEW <br />RISE Y/IXIX AND SQUARE FOOTAGE p VED <br />n F„ <br />+�. <br />PROPOSEOu E F <br />7m <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED 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 HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAWW118.22/7 RCI,W AND 296.200 WAC. /+ <br />LEGAL OESCgIPTKMl OF pIgPERrv15HOM1 BFlOW ORATTACN FOURCOPESI <br />LOT BIACK OF <br />PPOIEGi.lO0i1ERR <br />� 1' Mc F <br />EIfi1P.TNAA - / wTE <br />CRrRR/E6LYENFEM , <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO, <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—AMNDLG UNITS—H.P. <br />RATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />KITCHEN SINK E DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE E CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />9SUBTOTAL <br />SUB TOTAL E <br />E <br />1 A ' <br />PERMIT E <br />PERMIT E <br />I co <br />TOTAL FEE $1 <br />TOTAL FEE $1 <br />91 C5 <br />FOR OFFICE USE ONLY: <br />FTIIXIT SETBACK <br />REAR BEtBACR <br />SOESETBACR <br />FLAAIGHEOKWLARER <br />FEE <br />RECEIPTNQ. <br />uSE2 <br />LGTAREA <br />VACANT SRE <br />-- <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TrnacONrs.AuvNAEU <br />TFrtuEBBSTAEnut <br />naRHH+BwnA <br />S12EOFBLDG. <br />WDF STORIES <br />BASEMEW <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OGCUPANCYLOAO FIRE SPRNKIERSREDB HEOPRIMTATKW <br />REASON FM SAR01IBE0.S <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />INTAKE er <br />PLMrsnrvnwTDOY <br />CITY BF EVERETT <br />LOCAL SALES <br />TAX CODE IS ST05 <br />PUBLIC WORKS <br />TOTAL <br />