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� � � <br />Q��i <br />Q H <br />� H p� <br />y�H <br />�H� <br />'�I N �il <br />VJ H <br />xp <br />H <br />OHd <br />��g <br />H y q�g� <br />�H[jf <br />Hy <br />g�' <br />H <br />(i C7 [� <br />� � Cs1 <br />HOvi <br />��� <br />' '� <br />APPLICATIU'�•�! FOR CONSTRUC7�JN PERMOT �_� <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT <br />HEATING SYSTEM: ,�GAS ❑ ELECTRIC ❑ _ _ � <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />ovrt�ea ��.ni�,.no ess ❑rv zir a��or.— <br />P�a� M�ti �owl �.�G I I H_ o T��V��i's �I82o � 25°I- �Z64 <br />pT[fIANT <br />�AAiL DDRE55 P ��E <br />t\Or� vHONE <br />qqCwTECTOROE �GNER MAiLA�DRE55 CITv 2iP <br />��T, Zip PHONE STATE LICENSE � <br />GHlERA�CONiPACTOR MAILPD�RE55 <br />�c ssorv�NK <br />NEW ADDITION ALTERATION REPAIR <br />{�i��` <br />GONiRACiPRIGFOFWORK Iv �'� <br />IJF SCRiBE YlORN nND SOIIARE FOOiAGE INVOIV[0 <br />oF <br />�[GAl DESCRIPiION OF PROPEPTV �SHOWH B[LO�V O� �TIDC�� <br />i01 BLOGN �� __— <br />NO. TYPE OF FIXTURE OR <br />WATER CLO�ET �TOILET) <br />�ATIiTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISNWASHER _ <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />JRINAL <br />DRINNING FOUNTA!N <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />iRONt Si iMCN AEAH SETBACH <br />USEZONE <br />IYVF Oi CONtS. <br />wTnKE BV <br />TOTAL <br />LOTAREA <br />AIlOWA6lE n'PEOFCON4.ACNAI <br />�, NOAFSTORIES <br />LOAO FIRE SPRNNlEPS HEC <br />ISPRiNNLERS <br />a <br />PUNS PPOVE�BY <br />FEE <br />SiDE SET�PCN <br />DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />I CONiACT PERSON A110 PIIOYE NU . ... _. � <br />p /v-1 LU� <br />I HEflEBY CERTIFV THAT I HAVE READ AND EXAMWED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TVPE OF <br />WORK WILL BE C061PLETED WITH WHETHER SPECIFIED H[REIN OR <br />NOT. THE GRA4TING OF A PERMIT DOES NOT PRES'IME TO GNE <br />AUTHORITY TO VIOLATE OH CANCEL THE PROJISIONS OF ANV <br />OTHER STATE OR LOCAL Ll.VJ REGULATWG CONSTflUCTION OR THE <br />PER.'-OFiMANCE Of CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PPOPERTY TO PEFFORP: THE WORK FOR l'JiiICH <br />APPUC4TION IS M DE AND � COMPLY WITH THE STATE <br />CON7RACT0 S AW 1 21 R W AND 296200 WAC. <br />t / <br />� " ,��%�� ���1� <br />x-.-,— ��- — v— "."-v� ,.,n. <br />TYPE OF EOUIPMENT FEE <br />A�C—��HNDLG UNIT3—H.P. -TON _ . <br />FORCED AIR SVSTEMS—B.T.U. M E.A. . <br />UNIT HEATERS—B.T.U. M IOP n�iU ._�--.- <br />GIOTHES DRYERS - _._ <br />VENTILATION FAN � _. <br />RANGEHOOD — <br />WATER HEATER __ —. <br />METAL FIREYLHct s cnimrvei <br />FIREPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUST FAtJ <br />SUB TOTAL 5 <br />— FERMIT 5 <br />TOTAL FEE S <br />PL�N CH[CN N I.�BE� F( [ �iECEIPi NO <br />� J��4� <br />���� Tni nnnnu I FEE <br />BUILOING <br />OCCUFA4LY M1U OfpWFW:i�WiS � <br />°qp1° � PLUMBING <br />9ASEMENT MECHANICAL <br />HEiGHT u6UTnTtON ADDITIONAL PLAN CHECK <br />_ _ SPRINKLEfl <br />STATE OUILOING SUFiCHARGE <br />CITY OF EVERETT PU�IIC WORKS <br />LJCALSALES <br />TAX COUE IS 3105 TOTAL <br />