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APPLICATI�1 FOR COI�STRUCT _ �N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPAR7MENT HEATING SYSTEM: �GAS' U ELECTRIC J � <br />259 8810 <br />! � DEMOLITION COMBINATION 9C' BUILDINr �CMECHANICAL XPLUMBING SIGN <br />GWNER MAllA0DRE55 CITV ZIP PMONE <br />1-IcAtt;�.1�.::coo i-loateEs t�.P�� t3��x 2355 L+.�_v�nw�oD l,�A, �1803(0 -i71�I��13 <br />TENANT MNILqD�F.ESS CITV ZIP PNONE <br />ARGMITECTOROESIGNER MAI'.AUOFE55 CITV ZiP PH�NE <br />GENEP��CONTRACTOR MAILADURE55 CITY ZIP °HONE STATEIICENSEa <br />5Mu-e_ _FLea2rx�r- ����z <br />MECHANICAL CONTFACTOR MML AUDRE55 CITV 21P PMONE SZ3 - 7C�GSTFTE LICENSE N <br />ssc�cvar�o Nt�InNL� RC�� �3;�r 3oq �.noN2e�c� WA `�aR.'I� A55c�c.iz ,�r27 <br />PLUMBINGCONTP.ACTOR MAILAODRE55 Cltt ZIP PNONE SCF'WIJ�j �tAT��ICENSLN <br />_{�{��� C.cAsT `�c.umel_Al_�1 i i 2 /ku� E Sn�erion�is �l �i 62�i o w H � r� c P l�� pg <br />G�L/A55 OF W JRK <br />I/` NEW � ADDITION � � ALTERATION � RFP:11R DEMOLf�ION �. � WOODSTOVE/FRPL INSEFlT . BUILDING 9ELCCATION <br />� ..�/,,y��,!/ CCNTAGT PEFSON �N� PH/'O�/R�E NO. l�— <br />!:[1NTRPf:TPRICEOFIVORK ���']/�Sl7[i �f"�✓/� I KELI.�/ //'�u��� • •'- I��� <br />DESCRI9E WOFK AND <br />20�1 � <br />PROPOSEO USE OP BWLOINC <br />Si,�Gu= F,anti�w' 12t � o �1Cz <br />LEG�L OESCflIPTION OF PRGPERTV (SHOWN BELOW OR ATTFCH FOUR COPIES� <br />LOT BIOCN __ OF , <br />(-� i 1 SP 35 - <br />125 <br />PROJECTA�DFESS <br />oLUMBING <br />7� <br />�N77�7LGl7Y <br />TYPE OF <br />CLOSET <br />SHOWER <br />KITCHEN SINK 8 DI: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW Pf <br />ROOF DRAINS <br />[�7: <br />FEE <br />I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS'JF LAWS AND ORDINANCES GUVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHtTHER SPECIFIED HEREIN l�R <br />NOT. THE GHANTING OF A PERM14IT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR I.00AL LAW REGULATWG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI� PROPERTV TO PERFOqM Tf�1E WORK FOH WHICFi <br />APPLICATION IS MAJE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X(.�Q.z.l C�u� 2. / d o( 2 a <br />smnnmae onre <br />NO. TYPE OF E�UIPMENT FEE <br />— A/C—A�HNDLG UNITS�—H.P. <br />— J FORCED AIR SYSTEA15—B.T.U. M E.A. <br />— UNIT HEATERS—B.T.U. M i <br />( CLOTHES DRYERS <br />— VENTILAiICNPAN <br />�— � RANGEHOOD <br />� WATER HEATER �_ <br />� WOOD STOVE <br />� METAL FIREPLACE & CHIMNFY_ D' " <br />FIREPLACE INSERT <br />HEAT PUMP ' <br />� GAS PIPING � <br />d EXHAUSTFAN __ <br />ETC.) <br />— —� <br />SUB TOTAL S <br />PFRMIT 5 � <br />TOTCL FEE S , <br />FOR OFFICE USE ONLY: <br />FFONTSETB�CK REFRSET <br />� / � <br />❑SEZONE . LOTARLA <br />F- " / <br />rvee o: ccr+rs. auowne�.e <br />$J{�Qf B� <br />��� ! / � <br />OCCUPaI C� <br />�� <br />REASON FOR SPRINKLERS <br />INTAKE BV <br />rvFe ov cror+sr. acruu <br />NO.OF �SJTOFIES <br />FIRESPR LEFSREO'U <br />N� <br />PLANS APPROOED BY <br />SIOE SETB�K <br />� <br />VFCANi SITE <br />i08 TOTAL $ �✓/ ' <br />PEFMIT 5 <br />TOTALFEE 9 , <br />PLANLHECKNU61� R �FEE _� RECEIPTNO <br />3S %�,s� 307• `�S (1/3 /73 <br />BUILDING � '�Q — \} U' (%� <br />occuravn xoorvxewxeuwrs — / � <br />c„ ��v � ' pWMBIN� (.�"j�% � " <br />'3 N f - — <br />BaSE�nENi M1¢CHANICAL -��J; ` <br />MEIGH��ITaTiqrr ADDITIONALPLANCHECK �7i��� <br />n / <br />_ SPRINKLER <br />. <br />S7AiE BWLDING SURCHARGE `)L% <br />CITY OF EVERETT PUBLIC WORKS �G' �-"" <br />LOCAL SALES <br />TAX COUE IS 3105 TOTAL ����� j(j; j <br />