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APRLICATIO FOR CONSTRUCTI N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: J GAS J E! FCTRI � J _ I <br />259-t870 � � <br />DEMOLITION COMBINATION \ BUILDING MECHANICAL PLUMBING I SIGN <br />DVINEq IdAILPD�RESS ❑LY ZI? PIIJ.':E <br />�c;l,�h -�F'�,F�1C`C,S \ \ \T, �`� `-'���- `1- I/J\4,z�SJ�1�C t �1 � Gi`517C: (0 5> - -7 Q,�� � — <br />l TENANT MAR AD�F[Sc CITV Z�P PHONE <br />ARLWTECTOFOESIGNEB IAAILADOAE55 CITY ZiP FHONE <br />GEqERALCONTRACTOR MAtLADDFE55 GTV ZIP PMONE STATEI:CEHS[/ <br />O�v- �Q�L_ Z�k Z� 110-�,�- �P.+fE Ev P�/4'� _1,+.`4- <br />LIECHANiCAL CONTRAGTOR MAIL PDDRE55 GTY ZIP PHONE ETAtE LiCENS[ • <br />PLUIdBMGCONTRAG!nR MAiLADDRE55 GTv Z�P PNONE STATELiCENSF• <br />CONiRACT PRICE OF WOFK <br />�[SCRIOE WORN FNO SOVhRE FOOTAGE INVOLYED <br />PFO(F�O�S�ED� l.I-S.E OF BUIL� WG <br />LEGAI OESCFIPTION OF PFOPERTV �SHOWN BELOW OR ATfALH TWO COPiES� <br />LOT BLOGII OF <br />PARCELTA%ID.NUMBER <br />CONSTRUCi'�ON LOAN LENOf.R. <br />H0. <br />NN.18ER <br />OR ITEM <br />WATER GLOSET �TOILFT) <br />BATHTUd <br />IAVATOR'f (WASH RASIN) <br />SHOWER <br />KITCH�N SINK 8 CISP <br />DISHVJASHER <br />LAU�'DRY TRAY <br />CLOTHES VJASHE7 <br />URIPJAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BAi:KFLOW PREVENTERS <br />ROC)F DFAINS—RAWLEAD <br />SINI< ISERVICE—BAfl, ETC <br />SUBTOT�L 5 <br />PF:9MIT 5 <br />TOTALFEE 5 <br />FOR OFFI(:E USE OIVLY: <br />FRONTS[i�1CK �FANStlO�GK <br />USEZONE LOTAREA <br />r�rEOFmrisi rvo.oFsroaies <br />512[ OF BLOG. FIRE SPRMNLEflS FEOU <br />OLCUPANCY L0�10 FIRE AL�FM RW 0 <br />REASON <br />��,r,i�niu, -Tnvr�e�vi_ue, <br />enre <br />CON?AGT PERSON RND P40tlE N0. <br />i HERE�Y CERTIFV THA7 I HAVE FiEAD AND EXAMINED THIS <br />APPLICATION �ND KNOW THE SAME TG BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS ANC OFDINANGES GOVEFNING THIS TVPE OF <br />WORY. WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV i0 VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OF LOCAL LAW REGULATIIJG CO�lSTRUCTION OR THE <br />PEFi°ORMAhCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THL= WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPI.Y WITH THE STf�TE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC <br />r ��' � <br />i �,�i....;�..yi�ur.�,t•:� <br />MECHANICAL <br />FEE NO. TVPE OF EOUIPMENT <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 />GLOTHES DRYEPS <br />i VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />—�— WOOD STOVE <br />METAI FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />' GAS PiPING <br />—T EXHAUSTFAN <br />0 <br />SID.S.`.EIfI�Grc �IANGN[CHNUM�ER F�� <br />� /t � 9rJ �� <br />VACANT SIiE hCtJ <br />�-; YES � � NO Bui�o!nc <br />INS:FAIILv NO C�P�:[tl".:�.:'q �� <br />�'9p10� PLUTA�ING <br />BASEMFNi h1ECHANICAL <br />i : YFS :��. NO <br />MEIGMT UMITAnON �DDITIONAL PLAN CHECN <br />___ OTHER <br />STATE BUILDING SUFCHFRG[ <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CO�E IS 3105 TOTAL <br />i—.— <br />SUB TOTAL 5 <br />PEFMIT 5 <br />TOTALFEE 5 <br />necv-mr vo <br />VALUATION FEE <br />7� I � �� �' <br />� J <br />S � � `� �_� <br />