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APPLICATION FOR CONSTRUCTIL N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC E] <br />259-8810 <br />1-1 DEMOLITION I1 COMBINATION )f/BUILDING ❑MECHANICAL CI PLUMBING SIGN <br />owKER WLAODREss ".1 •< 1.— <br />Ey�RETr '1""/G dJr L,7e 1 1461 dvA4A h?E5A!7r WA 57POOZ �70- wa--5FuL <br />TENANT WL ADDRESS CRY ZIP PHONE <br />APCHRECiWDESNiNER <br />WLAWRESS <br />CRY <br />21P <br />PHONE <br />by +' Afli//rtrr5 <br />/c�o2 <br />!/HYrr ^v=� /-'yEREtT <br />ucq rba0/ <br />'Poe, a5f <br />6/ <br />OENERALCONiRACTOR <br />WLADDRFSS <br />CRY <br />ZIP <br />PHONE <br />STA1. LICENSE. <br />MECNANK:K TQI <br />WLADORESS <br />GTY <br />LP <br />PHONE <br />STATE LK:ENSEI <br />PWMBWDGYITRACTOP WL ADQIESS CITY ZIP PHONE STATE LICENSE. <br />LASS W WORK <br />rX oA /PmM I I nFMnI ITION I I WOODSTOVEIFRPL INSERT i I BUILDING RELOCATION <br />CONTRACT PPCE WV•VRIEAaW <br />CONTACT PEi1EOH AN IICfE Iq. <br />DESCRIBE WORK AND SQUARE FOOTAM WVQ <br />PROPOSED USE a Burtom <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF S P PERTY TO PERFORM THE WORK FOR WHICH <br />APPLICA ON IS ADE AND I COMPLY WITH THE STATE <br />CONTR TORS LA 18.27 WAND 296200 WAD, <br />x ( `1 <br />LEGAL CESCRIPTON W PROPERTY IBNOWN BEUMV OR ATTACH FOUR CWIESI <br />Lot— BLOCK W <br />PRaECi ADDRESS / <br />l4/l _ 2cY� l rYri_rs-rs'.7 �n,ecu <br />F TW L MTi <br />�u.RusWT,,,KT«:E»o <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—AIHNDLG UNITS—H.P. <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR GRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEAOERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK <br />REAR SETBACK <br />BIDE SETBACK <br />PLW CHECK HUMtlER <br />?7aa/ <br />FEE <br />— <br />RECEIPTNO. <br />%D98( <br />USE ZCNE <br />LOTABEA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />T'H 01"TE ALUAVARE <br />ZE'^ /, //,Y_ <br />(�Y� <br />TYPE, Fy,P.R'.LL <br />MMV_w <br />Aa MMERW6VPIF <br />SIZEWBLOO. <br />C.WSTWIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />ODOUIMNCYLOAD FIRESPRNKLERSREOO NEOHTUMRATKLI <br />REASON fOII iPRNKIERS <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />INTAKE BY <br />PLAN$ APPROVED BY <br />71MA-' U14 <br />CITY OF EVERETT <br />LOCAL SALES <br />I TAXCODEIS3105 <br />PUBLIIWORKS <br />TOTAL <br />;L (o9 ;VIA- <br />