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6UILDING DEPARTMENT <br />259-8810 <br />'7P1 PERNiII' �� <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC %�' I h� Cr S-� <br />L] DEMOLITION I_ I COMBINATION I� BUILDING I_l MECHANICAL ❑ PLUMBING ❑ SIGN <br />�O ER �O M IL� E55 \O CITY ZIP PMONE <br />� �18�� g _ � <br />TE f � ILADORES& CITV ZIP PHONE <br />� % -'- � n�? fl%r.�.L7a� �Lrizz! �'Ui �d'ZQ 77�-8�� <br />ARCHITECTORDESIGNER M411AD011E55 CIN ZIP PHOAE <br />GENEPALCONTRACTOH MAILqDDRESS CITV 21P PHONE STATELICENSEN <br />�2i-VE(�fPosBG� c <br />h1E HRNICAL CONT CTOR � MAI� RES �ITY 21P PNONE STATE LICENSE It <br />�J�cy�F�ce �1������or '�n� 61k� N6 � �Kt``�m-f{�e tg15� �06 �f89-o7Y'i <br />PL MBINC WNTRACTOR MAIL q�DRE55 LITV 21P PHONE STpTE LICENSE I <br />` �. CONTRACTPRICE WORN <br />x OESCRIBE WORK� <br />�_ 2�s � aence <br />\ PRO SED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTV (SNOWN LELOW OR ARACN T70 COPIES) <br />� LOT BLOCK OF <br />( PARCEITA%I.D.NUMBER <br />/� <br />CONSTRUCTIONLORNLEN�F.F. <br />N0. <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />F100R DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAIN�EADERS <br />SINK ISERVICE—OAR. ETC.I <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONiSETBACK REAFSETBACK <br />ttPE Oi CONSi. <br />OFBLDG. <br />REASON <br />L07 AREA <br />FIRE SPRINKLERS PEO'D <br />OATE � <br />ev <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAY1E TO BE TRUE AND CORflECT. 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 THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION �S MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />arv tlU5iNE55liCENSE NO ' <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT <br />� !vC—A+HNDLG UNITS—H.P. <br />; FORCED AIR Sl'STEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />' CLOTHES DRYERS <br />' VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE (WOOD BURNING) <br />� fIREPLACE INSERT <br />� HEATPUMP <br />; GAS PIPING <br />EXHAUSTFAN <br />VqCANT SITE FEES <br />❑ YES ❑ NO <br />BUILOING <br />IXCtIPANCY 110 OfpSFIlMGN1i15 <br />cxouv pLUtdBING <br />BnSEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION A�DITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHFRGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 5 <br />FEE <br />/7 /1 � <br />H <br />I <br />, <br />� <br />