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�4PI�LICATIC`"� FOR C0�ISTRUC�'�'l�N PE:RMIT �� <br />TO BE COMPLETED IN BLACIC INK—PLEASE PRINT <br />� <br />f HEATING SYSTEM: .J GAS U ELECTRIC ❑ <br />BU�LCING DEPARTMENT — --� <br />259-8810 <br />DEMOLITION COMBINATION %CBUILDING I MECHANICAL � 1 PLUPABIMG i 1 SiGN <br />ov;uea �+nnn�oaess cirv .ia aHeNe <br />3722 iiNt A�,e Et,erett 98201 ?52-&57`' <br />�ry-�� M1tAILhDOREbS GIN ZIP PHONE <br />4RCNITECI OR OESIGNER <br />CITV ZIP FHONE <br />GENEP4LGONTRACiOR EIAtLAD�RE55 CRY ZiP PMOI�E SiATLLICE45[R <br />�[tnGf 7m dta i3�rt17a�� ('�ardnes 11217�O1'h St NE i3:. Ste.•s�s i+A1 98258 334-9262 NOKII-G 12�IID _ <br />IAE;HANIGALCONiRAGTOP NAILADDRESS LIT\' ZIP PHONE STATELICENSEN <br />MAIL A��flE55 <br />CONiRfCT PPIJE OF WOPK <br />�ESCRIBE WORM,.�l:[l SOl1APE FOOTAGE INVOLVED <br />PfiOPOSED USE OF BUILOING <br />i.[Gnl0E5CRIPTION OF PpOPERiY �SHOWN BELOW OR aTT>CH M'0 COPIES� <br />�o,�a a�ocH12 oF LYidav lcl <br />f:0 �t _— _._. _ <br />�iiT'Y- / .[-�T � �S' I <br />PARCEt TAX ID. NUIdBEii <br />PROJC•CT ADDFiE55 <br />PLUMBING i <br />NO. TYPE OF <br />WATERCLOSET <br />S40WER <br />KITCHE�J SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRA� <br />CLOTHES WASHER <br />URINAL <br />DRINKINCi �OUNTAIN <br />FLOOR DRAIN <br />BACKFLON'PREVENTERS <br />ROOF DR. INS--RAINLEADE <br />SI��K ISERVICE—BAR, ETC.� <br />CITY ZIP PNONE STATE LICEIJSE � <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOF OFFICE USE ONLY: <br />FFlONTSEi6ACK, REARSETOACK / <br />� ri <br />USC ZONE y <br />�_ I <br />tvrE a�f C..o{_r157. <br />__�l[�L= <br />';AE OF BL�G <br />� f ro SF <br />occuPnr+cv iono <br />N/�- <br />REASON <br />MiAKE �� <br />LOT AREA <br />NO.OFSTORIES <br />/ <br />FlRE SPFMNLERS REO'0 <br />FIqE ALARIA RE00 <br />uo <br />PLANS APPf1'10\'1EU 9Y <br />'1�1 <br />DATE �] ��'J /�� <br />SIDESETBACK � <br />CONiACi PERSON AND PHO:JE NU. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND CORREC7. ALL <br />PFIOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WOF7Y. WILL BE COMPLETED WITH WHETHER SPEqFIED HEREIN OR <br />NOT. THE fRANTIN� GF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROYISIONS OF ANV <br />OTHER STA'I�E OR LOCAL LAW REGULATWG CONSTRUCTION OR THE <br />PERFOR�AAIJCE OF CONSTRUCTION. THAT I AM HUTHORIZED BY THE <br />OWNER OF iH15 PROPERTY TO PERFOFlM THE WORK fOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT � LA�vV 1827 RCW AND 296200 WAC. <br />���.,.�� � ���� � �� <br />�, � v r,usive ss uceusr ao <br />IdECHANICAL <br />V0. TYPE OF EUUIPMENT FEE <br />A/C—A'HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHFS DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />VlOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) ' <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING ' <br />EXHAUSTFAN <br />5 _ <br />5 — <br />PLAt1CMELKNl1U9EN FEE � FECEIPTND <br />��1��l� �ly � �'- /_C.=` <br />VAGANT SiTE rc�o <br />I � YeS . . NO BUILOING <br />rcccr;.r.v xoormnuixsu•ar -- <br />��°" � � PLUMBING _ <br />PI � <br />BnsEMEntt / MECHANICAL <br />I_1 YES .✓NO <br />HEIGHTI.IMITATION AODITIONAL PLAN CHECK <br />y t > OiHER <br />STA7E �UILDING SURCHARGE <br />�ITY OF EVERETT PUBLICIVORKS <br />LOCAL SALES <br />TAX CODF. IS 3105 TOTA� <br />