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APPLICATIC�''�1 FOR COPISTRUCT'"1P� PERMIT � <br />TO BG COM?LETED IN SLACK INK—PLEASE PRINT <br />HEATING SYSTEM: `�j GAS ❑ ELECTRIC ❑ --� <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEM6LITION CJ �OMBI�ATION �3UILDING ��MECHANICAL f�PLUMBING ❑ SIGN <br />O\7NEfl ldqlL ��DflE55 � CITV ZIP PHONE <br />� <br />��� �ra�r ,/'���- i�a� 775� ��ic? `id�1.�� .��,2-�! j/r' <br />TENANT AILADD3ESS CRY ZIP PNONE <br />JEH IdAILADOFESS CITY ZIP PHONE <br />'re!'s ��,c l�r c,<<,J _ z.,�� -�i Z�U <br />)R MAILn0�RE55 CIiV ZIP PHONE STATELICENSEn <br />o.r/- /l�,�r.s C'a,�-e__ D�.��,il, �?3 /�T <br />CTOP ~ MFIL PDDRE55 CITV ZIP PNONE STATE LILENSE a <br />PLUMBING LONTRACIOR lIAIL AODRESS CRY ZIP PHONE _ STATE LICENSE k <br />CONTRACi PNICF OF <br />OESCRIBE WORH �ND SOUARE <br />PPOPOSED USE OF OUILDING <br />INVOLVED <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELO`W � <br />LOT �� BLOCN �J%T �F( <br />!- O /1_ , _ i_ <br />PARCELTA%I.D.NUMBEfl <br />'d.d� ` ) J 6' <br />�l! i4 �( / O �GL� <br />PLUMBING <br />NO. TYPE OF <br />7 WATER CLOSET <br />SHOWER / <br />KITCHEN SINK & DISP � <br />DISHWASHER <br />LAUNDRY TRAY - <br />ci nrucc wncuFa � <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL0IN PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERI/ICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK RE�1R: <br />� <br />USEZON LOTAL <br />TVPEOFCONSi. NO.OF <br />2i`1t �SF'�" <br />f3S3 SF G <br />OCCUPANCYLO�D <br />REF50� <br />INTAKE BY <br />TOTAL S <br />MIT S <br />FIRE SPRINKLERS REO'D <br />UFiE <br />� /� <br />"C ""'� <br />CONTACT PERSON AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SRME TO BE TRUE AND CGRRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE 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 CONSTRUCTIO�. THAT I AM AUTHORIZED BY TH� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIOM IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RC�W AND 296.200 WAC. <br />FEE NO. TYPE OF E�UIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />� ci nTucc navFas �— <br />SIDE SETBACH , / <br />5 <br />VACANT SITE <br />❑ YES ❑ NO <br />pCCJi:ALY NO Cl�WFLLI4GON'�15 <br />BASEMENT � � <br />C'� 1'ES i4'NO <br />MEIGHi LIA!ItATION_ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CQDE IS 3105 <br />VENTILATION FAN <br />RANGEHOOD � <br />WATER HEATER — <br />WGODSTOVE <br />FIREPLACEINSER7 <br />HEAT PUMP <br />GAS PIPING � <br />EXNAUSTFAN <br />BUILDING <br />PLUId81NG <br />IdECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER , ��I���J <br />STATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />PERMIT <br />TOTAL FEE <br />/ flECEIPT NC0. <br />• / �) �( �, ) <br />1 <br />