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APPLICATIC l EOR CONSTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BL4CK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: �f GAS J ELECTRIC J __� <br />2u9-8810 / <br />DEMOLITION COMBINATION BUILDING vMECHANICAL PLUMBING SIGN <br />JltitlEP I,IpI�ApORE55 CIiV ZIP PMONE <br />�,�t �3e�, au7� _b'�/�a ff�/hra� Q���r�ti ,-� �-6 i�s- <br />�r+nrvT � �.+a�aoorEss '—' cirv na aHorve <br />���%�� <br />nNCNRECTORDE5IGNER MARADDRESS CITv ZIP PHONE <br />GENERALCONTRACTOR I.IqIIADOFESS <br />CIiV ZiP PNUNE STATELICENSE• <br />IdECHAMCALCONTPACtOR MAIIApDFESS CIT\' ZiV PNONc StPi[UCENSE+�13S7,S <br />oa-l- ��� �?�.�,=�o.� S"y ����J�/��Su�LL� �la �UD�?ffAN077Li4 <br />UM1191NGCONTRACTOR M41LAD�R[55 CI1V iP PNONE STATELICENSE� <br />�'� 1 <br />WNiR�CTPRI O C <br />�j� � ��� <br />JESCRI9E WORN ANO SOP4RE FOOTqGE INVOLv�_D _ <br />LEGAL DESG�PTION OF YFiOPi <br />�or oiocK <br />PAPCFL TAY I p. NUM1IDER <br />r <br />CONTACT PERSON AND PHONE NO. <br />—� I HEREBV CERT;FY THAT I HAVE READ AND EXAMINED THIS <br />APPLIC�TION AND KNOW THE SAME TO 9E TRUE AND CORRECt ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />oE�owoaniincHnvocori=_s WORK WILL BE COMPLETED WITH WHETHEA SPECIPIED HEREIN OR <br />– oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUA9E TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br />PERFORAtANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />-- APP�_IC4TION IS MADE AND I COh1PLV WI1H THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />CONSTRUCTIONI.O�NLENDER.�DDR[SS.TELEPHONE NU1d0[R <br />PROJECT <br />_S ii� H,/��� nn y� <br />PLUMBING <br />NO. TYPE OF FIXTUFE OR ITEM <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINI( 8 DISP <br />DISHWASHcR <br />�LOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PF[VENTERS <br />(SERVICE—BAR, ETC.) <br />FOH OFFICE USE ONLY: <br />FfiONi5Et8AGK REARSFTB�CK <br />USE ZONE <br />IPFE OF CON57 <br />SIZE OF 6LOG <br />OCCUPFNCYI <br />RFASON <br />ir�rnkE or <br />LOiAR[A <br />na <br />—� <br />SUBTOTAL S <br />PERMIT 5 —� <br />TOTAL FEE S ' <br />SIDE SETBACK <br />F10E SP^INNlERS REO'D <br />nim�snvrnoveo ov <br />i�ni� <br />V4C4Ni5RE <br />- �. YES ,– NO <br />06l]Pa�N NOIXOW[LLIhGUM1��` <br />�on�n <br />BnSEMENT <br />YFS ^ NO <br />MEIGHT llldllATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COUE IS 3105 <br />x_ � ��{��('(���' '2--�� `� <br />smrv+*unc ---c� \ w*c <br />crtvnus.r¢ssucr�si r�o <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />Whi[RHEATER �f <br />WOOD STOVE <br />AIETAL FIREPLACE (WOOD BUPNING) <br />FIREPLACE INSERT <br />HEAT PUMP � <br />GAS PIPING : <br />�UILDIN3 <br />PLU�+BING <br />tdECHANiCAL <br />ADDITIONAL PLAN CHECK <br />OTNER <br />STATE �UILDING SURCH�RGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FE[ I RECEIPi N0. <br />0 <br />H <br />� <br />N <br />e <br />