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APPLI�QTIOI _ �O� CO�VSTRtlCTI N PEl��'d�li �� <br />TC �E CUMPLETED IN BLACK INK—PLEASE PRINT •rr <br />i HEATI�G SYSTEM: J GAS �,J ELECTRIC J v �Lf.?1_/jliy-� <br />BUILDWG DEPP,RT�✓1ENT <br />259-8810 <br />DEMOLITION C01.181NATION _ BUILDWG "1ECHANICAL �PLUMBING SIGN <br />'.ER 6!AILAG�RF.58 CItV pH04E <br />!'/%-yc y < ✓�c�� �6 /s— �l�� ��-�� �/b��'/ � S �' z S. ��' <br />.!::tli MAILpDDRE55 LrtY . PHONE <br />� <br />. �J��ITECTORDESiGNER tdpiLApDFE55 CITY ZIP aHONE <br />� .',.r.1dING <br />'O'JLRACT PRICEOF WORN <br />MAIL ADDRE55 <br />ranr. Rooaess <br />MAII. ADORESS <br />._:iCR�BE WOFK ANO SO�ARE FOOTAGE INVO�V't0 <br />Uti4� 1' �` <br />r ��,cNoseo us—e oF� <br />! rGAL OESCRIPTION CF PqOPEPiY (SYO'NN 2EL01 <br />lCi BIOCK OF <br />rnFLELTAXID.NJMBER <br />',�IPU:;TION LOAN IFNeER. hUDRE55. TEIEPHONE NpMOER <br />PROJECTADDRESS � � <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTU� <br />LAVATORY (WASIi BASIN) <br />SHOWER <br />i<ITCHEN SINK 8 �ISP <br />� DISHWAfiHER <br />LAUN�RYTRAY <br />�' CLOTHES WASHER __ <br />URINAL <br />DRINKING FOUNTAIN <br />FL009 CRAIN <br />CITV 21P CHON[ SiFTE l IGENSE t <br />CIIY LIY <br />CITV ZI? <br />PMONt <br />PHONC STATELICENSEA <br />CONTAGTFERSONANDPNONENp. �`(�,� <br />J <br />�''.�'�iGc�l ��r . ;� <br />—{ i HEREBV CERiIFY THAT I HAVE READ AND EXA�dINED THIS <br />APPLICATION AND KNOW THE SAfdE TO BE TRUE AND CORRECT. ALL <br />__ PnOVI510NS OF LAWS AND ORDINANC[S GOVERNMG THIS TYPE OF <br />rnocoPiesi WORK V:4L BE COMPLFTFD WITH WHETHER SPECIFIGD HEREIN OF <br />P10T. TFIE Gn"NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR G^��CEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCiION OR TIiE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TH'r. <br />OWNER OF THIS PROPERTY� TO PERFORM THE WORK FO�; WHirH <br />APPLICATION IS MAUE AN� I COi�1PLY WITH THE SIAT[ <br />CGNTRACTORS lAW 18.27 RCW AND 296.200 WAC. <br />��.�-� — `� � — � -- <br />>�u u.�c <br />crtri u�ir.scr.o <br />TYPE OF EOUIPMEN7 � FEE <br />A�G–!�.'HNDLG UNf!S—H.R � <br />FORCED AIR SYSTEh1�—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHeS DRYERS � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER �� <br />WOOD STOVE <br />METAL FIREPLACE (WOOD ElURNINGj <br />FIREPLACE INSE9T <br />HEAT PUMP � <br />GAS PIPING ' <br />EXHAUSTFAN � <br />SUB TOTAL S <br />PERMIT � <br />TOTAL FEE 5 <br />FOH OFFICE USE ONLY: <br />�_. m e E*oncn r.enn seTencH <br />I;:;IZOiE LOTr1REA <br />� �: N GUNSi. I NO. OF STOqIES <br />.�_'FCPBLDG. iIflESPflINN'E43RE0'0 <br />.'.�]PnNCVLOAD FIRERV.fil.IREOD <br />r,n„ou <br />�nr��rt+v I ��nNsnvvRoveoev <br />SIDE SET9ACK � P�A'J <br />I raGnrrtSirE PEES <br />; �� YES �� NO ouaoir�� <br />acu�xxtt neaowtwvcw:��s — <br />eaouv FWM�ING <br />BASEME`IT :AECHANICAL <br />��: i YES ,- NO <br />HEIGNTUMIiATioN AODITIONALPLANCHECK <br />_ OTHER <br />STATE BUILDING SURQIAFGE <br />CITY OF EVERETT PUBLIC WORKS <br />, LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />FE[ <br />—� <br />SUBT(`,iAL $ <br />?ERMIT S <br />�C��ALFEE 5 . � <br />ncceiNrn�o <br />---__._ _ _--,— <br />i <br />