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� <br />APPLICATIa_i FOR CONSTRUCT''�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SYSTEM: 'rJ GAS ] L�ECTRIC J � <br />259-8810 <br />' DEMOLITION �1COMBINATION �=1 BUILDING ; 1 MECHANICAL L; PLUMBING SIGN <br />OWNER MAII RD�RE S CITY 21P PMONE <br />G/�V� R fbS'fi�P'i"� ,�? O. �k' S'23'� �d�P�'Y' 9ezo,G 3 3 7� J� i 7 <br />TENANt <br />ADDliE55 <br />I�P PNONE <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITV ZIP PHONE <br />MAILADDRE55 CITV ZIP pHONE ST�7ELICENSEt <br />MECHANICAL CONTR�CTOR MAIL AODflE55 QTV 21P PNONE STATE LICENSE � <br />PLVN.BING LIXJTR�CTOR MAIL ADDRESS QTV 21P PMONE STATE LICENSE � <br />CONTAACT PRICE Of <br />DESCRIBE WORK <br />BUILDING <br />L <br />� <br />�NVOLVED <br />�Xr.sri�uG G �+�'�- <br />r.0 G,9�9�'.E ��x�2 2 <br />LEG�LDESf�$IPTIONOFPROPERTY�SHOWNBELOWORATTAC%TK'OCOPIE51_�� �� <br />�oT � � BLOCK �� ` OF � ��'� '� <br />Grl 7 �P' .A.OD/T/O it/ . �; �/.F.�ST ) <br />LOr L.6r� .7'/ ' � <br />PRRCELTA%ID.NUMBE/A �� / <br />5��00 T <br />CONSTRUCTION I.OAN LENDER. RODRESS. <br />vnae2 � 2�o HSd <br />PLUMBINfi <br />NO. TYPE OF FlXTUI <br />WATER CLOSET (TOILE <br />BATHTUB <br />LAVATORY �WASH BASII <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVE Ei <br />ROOF DRAINS—R NLE <br />SINK (SEHVICE AR. E <br />� �2�'. � <br />�j �OD� <br />N!E NUMBEH <br />SD� �V� <br />REM FEE <br />SUB TOTAL $ <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONT SETB�CK REAR SETBACK <br />� � / <br />USE ZONE LOT RRE <br />� �7 <br />v <br />71PEOiCOHSi. NOAFSTORIES <br />V - �I <br />SIZEOFBLW. FIRESPRINKLEBSRE�'D <br />iJ-r.k0 2 i_.ti N C <br />OCCUPANLYLORD <br />HA <br />INTAKE BV <br />�� <br />ia- c-�� <br />SIDESETBAIK � <br />CONTACT <br />i HEREBV 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 HEPEIN UH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO C�IVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PflOVI510N5 OF ANY <br />�OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 W AND 296200 WAC. <br />�_ 3�z1^7� <br />S�GN�NRE p�iE <br />CITV BUSMESSIIL[NS[ NO <br />MECHANICAL <br />�10. TYPE OF EQUIPMENT FEE <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />VACANT SITE FEES <br />I.—: YES [l NO eui�oiNc <br />OC[01PN[V NO.pbMFCJNGUN�iS <br />iBCp° PLUMBING <br />_ � <br />BASEMENT �� MECHANICAL <br />"7 YES ir� NO <br />HEIGHT LIMITATION AGJITIONAL PLAN CHECK <br />�� / OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 �r�� <br />SUB TOTAL $ <br />1 <br />