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APPLICATIC` 1 F�R CONS7RUCT' 1N PERMIT �� <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT <br />HEATING SYSTEM: 'J GAS J ELECTRIC �.J <br />BUILDING DEPARTMENT — -- <br />259-8810 <br />DEMOLITION C.7MHINATION BUILDING (� MECHANICAL PLUMBING SI9A' <br />6 �CMANIClL CONTRACTOq <br />?W61B�NG CONTflnCTOR <br />GONiRAQ PHICE OF CfOfll <br />�j <br />oescaieE w¢ryc allo "sou� <br />< <br />M�IL AO�FE55 <br />,b �', /oZ <br />IAAIL AOJR�55 <br />IAAIL ADURE55 <br />IdMLA0DPE55 <br />MA�i A�DRE55 <br />�� <br />FOOTAG� [ INyOLVEI <br />.� <br />c� <br />� � �G <br />GIP' �!� _� 1�� <br />G �-�` � <br />CIIY ZIP <br />CITV Z!P <br />_G_ ` <br />/j — � CITY ZIP <br />• / / <br />ZIP <br />C�iV ZIP <br />'zJ�po-o <br />PROPOSED USE OF P! m OING <br />LEGAL �ESCRIPLION OF PROPER ^,SHON'N BELOW OR ATTACH TWO COPIES� <br />LOi BLOCK — pF — <br />�.� P.�,-�( � (3 �( ( �Z % <br />��.+Hce� Tnx i.o. Nun+eea <br />CONSTRt1CTiONIOANLENDER.ADOREFS.iELEPHONENUMCER <br />PROJECT AQDRES$ / . � <br />TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />IAVATORY (WASH BASIN) <br />SHOWER <br />KITCH[N SINK 8 UIS? <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACi�FLOW PREVENTERS <br />ROOF DRAINS—HAINLEADERS <br />91NK (SERVICE—BAR, ETC.) <br />�UBTOTAL 5 <br />P�RMIT 5 <br />TOTAL FEE S <br />fOR OFFICE USE ONLY: <br />FHONTSEiBACN PEAR SETBACH <br />USEZONE LOTAREA <br />nPi0fL095t NOAFSTORIES <br />SiZG OF BL�G. FIFE SPRINNLEPS REO'D <br />OCCUPANCY LOAD FIRE ALARM BEOD <br />M14V.tL�Y PLANSAPPROVF.D�V <br />on,c <br />CONiACT PERSON TND PHONE NO. <br />�„or�e <br />'�NE <br />PHONE <br />PHONE STAT[ LICENSE C <br />✓�J <br />HOIIE STAT[LICENSEe <br />PHONE STATE IICENSE a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION P.ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE CR�NTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER ST,\TE OR LOCAL LAW REGULATING CONSTRUC710N OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM .1UTHORIZED 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 LAW 18.27 RCW AND 296.200 WAC. <br />NO. TYPE OF E�UIPMENT <br />NC—A�HNDLG UNITS—H.P. <br />(j FORCED AIR SYSTEMS—B.T.U. M E.A. <br />/ UNIT HEATEPS—B.T.U. M <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL PIREPLACE <br />FIREPLACEINSERI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIOESE76A^,H �LANCH GKNUld�[R <br />�(�C�% <br />vncnNi site FEES <br />: YES � : NO BUILUING <br />cauraucv r:oarowtwucsans <br />cuouP PLUMBING <br />BASEMENi MECHANICAL <br />VES .- NO <br />NEIGHT WdiTnTiDN ADDITIONAL PLAN CHECK <br />OTHER <br />STA�E BUILDING SURCHARGE <br />CITY OF EVERETT Pl1BLIC WORKS <br />LOCAL SALES <br />TAX CO�E IS 3105 TOTAL <br />BU <br />SUB TOTAL S <br />PERMIT � <br />TOTALFEE S <br />�p <br />n <br />WM <br />e <br />