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f <br /> APPLICATIOtr FOR CONSTRUCT11rN PERMIT e"��°c� <br /> iw E�erq�aun TO BE COMPLETED IN INK—PLEASE PRINT � <br /> r GTV OF <br /> � tr1 � everetf HEATING SYSTEM: GAS ❑ELECTRIC 0 <br /> p � x BUIIDING DEPARTMENT <br /> 9 y � 259-8810 <br /> � DEMOLITION �(,COMBINATION �,BUILDING ❑MECHANICAL ❑ PLUMBING �f❑ IGN <br /> ~ � .�.� MAiLA0DRE55 QiV � ZIP PNONE ��U`� <br /> y �,�,+RU�1�zr-K ,.Tiidv� � {IUZO n'�t.c� 54tiL��,�(�,��1 �Z��- �3 �/; <br /> O x. O TENANT AIAILADOPE55 CIP� ZiP <br /> HN� <br /> x eRCNITEGTOR0E51GNER • �AILADDRES6 Glif 21P PNON`_ <br /> DLL� C�r�,E ,�'.4r�nina �S'�r�lls�2) l�lR� ���-l7ay <br /> O H � GEN I�LCONIPAGTON ��ll�UDRESS CITY � 21G PNONE uCENS�• <br /> H �� ��ur�rk .�xlus 7�Um �I��I.ifl_ <br /> ��' n AIECHANiCALCONIRACiOR �AILAODRE55 GITY 21P PMOnE 4CEHSE� <br /> -�i y� GLUMBINGCONTRACTCR MAII��URESS CITY 21P PNONE UCENSE• <br /> HH <br /> N <br /> H C S OF N'ORK <br /> n�N �NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFRPL INSEFT U 6UILCING RELOCATION <br /> r CONLAGL PENSON 0.'1�PHORE N0. ` /� <br /> [tf -- / ��C� U '.J3� '�-^� <br /> y O y CONiRAGTPRICEOF\YORN <br /> OESCNIBEWORKANOSOU�REFOOTAGEINvq.VE� �� ^�r� � k 3S3—yg��; <br /> o �� � ' ��'.L �Xhc✓1� <br /> vnoPoseous6oremioi � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS� <br /> � � n APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> S � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE QF <br /> iEc.�oej RIPTIONOfPROPERtt�5H0 NBELOWOR TTACHiWRCOPIES� _v� ` WURK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �pi /� OLOGK OF � � NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> AUTHORITY �i0 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAY!REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AA1 AUTHORIZED BY THE <br /> //� / ' OWNER OF THIS PROPERTY TO PERFOPht THE WORK FOR �VHICH <br /> ,! Y � APPLICATIO1J� IS MADE AND I COMPLY WITH THE STATE <br /> CONTyACTOR$LAW 1827 RCW AND 2962(l0 WAC. <br /> S�GNATVREOFCONTR� OR�jU1�RRE0AGENT O�iE <br /> !(L�� fn`�—.. <br /> � , I �` / � <br /> RpJEGTA00PE55 ���� � � � -� -����4����� /C� `� — <br /> '�� � APPLICANTSG1TYBUSiNE55UGEN5EN0.ANOBU51NESSNM1E <br /> ' f PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> '+� WATER CLOSET(TOILET) �— A/CrfUHNOLG UNIT$—H.P, <br /> BATHTUB r'" FORCED AIR SYSTEAIS—B.T.U. M E.A. <br /> � 1 ' "3 LAVAI�ORY(WASH BASIN). ;= UNIT HEATERS—B.T.U. A1 � <br /> � SHOWER � CLOTHESDRYERS ' <br /> �' KITCHEN SINK 8 DISP �� VENTILA.TION FAN <br /> 1 I �ISHWASHEH � RANGE HOOD ' <br /> '��p �LAUNDRYTRAY i WATERHEATEfl ' <br /> CLOTHES WASHEP �'� WOODSTOVE � <br /> a � METAL FIREPLACE&CHIAiNEY ��)' �' <br /> URINAL <br /> ��' DRINPING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN �' HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> 1 ROOF DRAINS—RAINCEADERS � EXHAUST FAN — <br /> � SINK(SERVICE—BAR.ETC.) S� � <br /> t—1 � ---r— <br /> i <br /> Is' SUB TOTAL S ' n�1 �=" SUB TOTAL 5 - � <br /> PERh11T 5 PERMIT S <br /> TOTALFEE S ' TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK�' �� SI�ESETOACK PUNCNECHNUM!lEN FEE RELEIPiKO.� �� <br /> � <br /> z�- ��n �,�� � ' 3�v�sJ 3� ' 7.� �.:j . <br /> USE20NE �✓, IOTMEA VAC.WTSITE FEES VALUATION FEE <br /> - Z 7 7 0 5 y�� eui�owc p �D J�— <br /> ivPEOfCON1SAlOWABIE . lYPEOfCON57.ALiUAI oauvun Aa.aonnu+cwlns � _ <br /> _�J �"01' ( PLUMBING DJ� <br /> SQEOFBLDS3�, t NOAFSTOFIES � OASENEN7 MECHAKICAL ✓ � � <br /> �67,7 55 Z � <br /> OCCUPAHCY LOAD FIRE SPRNNLERS REO'� NEIGHT 4MITeT�ON ADDITIONAL PIAN CHECK T <br /> /`/J Z� OTHER <br /> REASON ORSPRiNKLERS <br /> STATE BUILDING SURCHARGE � ���'�� <br /> i - <br /> IN��. =0Y PlANSAPPFOVEDBY CITY OF EVERETT PUBLIG WORKS ��J� <br /> //1 LOCALSALES <br /> `M g i�4t TAXCODEIS3105 TOTAL l �d ;J� <br />