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f ' <br /> APPLlCAT14N FQR CONSTRUC7 .ON PERMlY <br /> TO BE CJMPLE'�EU IN BLACK INK-PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: - GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING MECHANICAL PLUMBING I SIGN <br /> OWNEI �/P/V ��`�(�ql�! ��j�r.�� /�'/r /�li/CY'� ��/AI�(f�l 1 ��(/�ONE —�I�f ��`1/\ / I�� <br /> l <br /> TENAN��� N���M�ILFDDPESS ��+♦ ZIP PHONE' <br /> // <br /> // <br /> ARCHITECTORDESIGNER MAILADDRESS CITV ZIP PMONE <br /> GENERALCONTRACTOR MFILAOOflE55 CITV ZIP PHONE STATELICENSEa <br /> ���� <br /> ldECHANICALCONTRACTOR MFILADOflE55 CITY ZIP PHONE STATELICENSEa <br /> PLUMBiNGCONTRACTOR MAILADDRESS CITV ZIP PHONE STATELiC[NS[e <br /> CLASS OF WORN <br /> �. NEW . I ADDITION . � ALTERATION . �. REPPIR . . DEMOLITION �OODSTO�E/FRPL WSERT I . BUILpING RELOCATION <br /> CONiACT PEqSON AND PNONE N0. <br /> CONTRACT PflICE OF WORK <br /> DESCRIBE WORN AN�SOUARE FOOT�GF.INVOlVEO ' <br /> Pi.OPO5EDU5EOFpWLDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGALDESCRIPiIONOFPPOPEFTY(SMOWNBELOWORATTACHFOURCOPI[5� PROVISIONSOFLAWSANDORDINANCESGGVERNINGTHISTVPEOF <br /> WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCH oF 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 RFGULATING CONSTRUCTION OR THE <br /> PEflFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM �(HE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��� �, �'�a%����-�_ //,�-/9/ <br /> PROdE/CfTAODFESS � �� unE ' i[ � <br /> •(�( / (/L/� QiVOVSM[55UCF15EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMEN7 _FEE <br /> WATER CLOSET(TOILET) � A,'C—A,�HNDLG UNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDFYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN ; <br /> DISH WASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATEfi <br /> CLOTHES WASHEF WOOD STOVE Q I — <br /> URINA� ; METAL FIHEPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIId HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> _ <br /> i <br /> —T— <br /> i <br /> SUB TOTAL $ ; SUP TOTAL 5 <br /> PERMIT S PERMIT b <br /> TOTAL FEE S TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACK REARSETBACK SIDESET�FCH PLANCHECKNUMDEF F L/� RECEIPTNO. <br /> 5 i <br /> JSEZONE LOTAREA VACFNTSITE FEES .4!!!*Y.`JN� FEE <br /> BUILDING ; <br /> IvfEOFCONTS.ALLOWABLE TYPEOFGONSiAC7UAL a[u>nxCr im.ofowuux,u':n5 — <br /> cnouv � PLUMBING <br /> i <br /> 92EOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL <br /> OCCUPANCYLOAp FIRESPRNNLERSREO'D MEIGHTLIMITATION ADOITIONALPLA�JCHECK <br /> SPRINKLER <br /> P.[ASON FOft SPFINNLEPS — <br /> S7ATE BUILDING SURCHARGE <br /> rtlineL In PLANSAPPPOVED�Y CITY OF EVERETT PUBLIC WORK$ <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAI <br />