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APPLICATIC ] FOR CON�iRUGi. )I�i PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HE_4TING SYSTt�J.: �j GAS � ELECTRIC �J � <br />253-881C <br />DEM�LITION COMBINFITIQN <br />OC:`:ER ldqn.A0DRE55 <br />AHCHITECT OP <br />IdAI� ADDRESS <br />MAIL ADDR SS <br />BUILDlNG XMECHANIrAL I' pLUMBWG SIGN <br />QTY ZIP PHONE <br />(:IIY <br />� <br />CIiY <br />ZIP <br />ZIP <br />GF.N[R4LC04TRACTOF IdqILA0pRE55 CITY ZIP PHONE STFTELIC[NSEu <br />_�t1313 C'C�I.�iT <br />6'ECHAHICALCCNTHACTOF I.1qIL4DCREiS CRY 21P PNGNE SiATELICENSEs <br />rH <br />�L1Et iIMITI-�� %//�-z'O Su.� !4./TL�ick�llC�� �'I86�1.3 3GZ��30 199ET/�L2^K1�/C�'7 <br />PLUVpiCGCO�lTR�CTOR lAFILADpRESS GIiV 21P °NONE STATELICE�ISF> <br />CONIRAGTPRIGE <br />DESCfiiBE WOFK AtJD SOUFFE FOOIA[E INVOLVED <br />Ae <br />PROPOSED JSE OF Blllt DING <br />Q.1� QC,t-� <br />LEGAL �ESCPIPT�JN OF PROPERTV ISHOV/N DELOW OR �TTACH TWO COPIES� <br />LO: -- BLOCK OF <br />vnNce inx i o r+ur,!5ea <br />� 3`�/-'y8�1 -Gor •ooa3 <br />COHSiRJCTI�NLOANLENDER.FDORESS.TEIEPHONF.NUlABER <br />PLUMBING <br />O. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />B.4THTU8 <br />LAVATOR" (WASH BASIN) <br />SHOWER <br />KITCHEN SINK R DISP <br />OISHWASHER <br />L�UNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />�ACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR. ETC <br />FOR OFFICE USE ONLY: <br />FRONiSETBACK qEAii5ET8�CN <br />USC:ONE <br />rr��e ov cn��sr. <br />SREOFBLDG. <br />OCCUPFNCVLOAD <br />RE<SON <br />iu.,,�cav <br />IIiA�4 <br />SU8 TOTAL <br />PERMIT <br />TOTAL FEE <br />�OT �REA <br />N0. OF STORIES <br />FIRE SPRINKLERS RE00 <br />i1RE AL! RM REOD <br />v�aru <br />�� <br />DY <br />FEE <br />SIDESETB/+CK <br />us"a�l _ zoG <br />TF/� ir✓� <br />z' zy3o <br />I HEFEOY CERTI"rY THAT I HAVE READ AND EXAMfNED THIS <br />AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORREGT. "LL <br />PqOVISIONS OF LAWS ANU ORDINANCES GOVERNING I�HIS TYPE OF <br />WORK WILL BE COMPLE�iED'.NITH WHETHER SPECIFIED HEREIN (�R <br />NOT. TNE GRANTING OF A PERMIT �OES NOT PRESUME TO G'NE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOhS vF F,NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUG710N OR THE <br />PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHJRIZED BY THE <br />OWNEF OP THIS PROPERTV TO PEPFURM THE WORK FOR VlNICH <br />APPLICATION IS MADE ANCJ I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2� RCvqiAND 296200 WAC. <br />TYPE OF <br />FORCED AIR SYSTEMS—B.T.U. � i E.A. <br />UNIT HEATEFS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOC <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WGOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS YIPING <br />EXHA:IST FAN <br />PLA'� C��ECK NUIdpER <br />- YES "- NO <br />�UILDING <br />occuvcnvr xoo�w,mwcuens <br />caow <br />PLUMBING <br />BASEMENT MECHANiCAL <br />YES NO <br />HEiGNTur.uTnilON ADDRIUhALPLANCHECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL 5 <br />PERMIT 5 ��I <br />TOTALFEE 5 � <br />F[E PEC[iPiNO. <br />VALUA710N FEE <br />i <br />