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■ <br />��y� APPLICATIO�nI FOR CONSTRUCT..?N PERMIT/ <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ItYr i�r* <br />BUILDING DEPARTMENT HEATING SYSTEM: Cl GAS j� EIECTRIC ❑ � <br />259-8810 <br />I DEMOLITION i COMBINATION <br />OWNER MAILAO�RESS <br />�ar5Ye4.v�. 3�G0 �c,� <br />TE/NJRNT <br />//[ [� L <br />X BUILDING MECHANICAL :' PLUMBING SIGN <br />CITY ZIP PHONE <br />,I S, .P�l� C b-,.. I n c'i —.. . G-� <br />MNILNpOFE55 CITY 21P PHONE <br />iC.l7�r �,�, � <br />MFII A�DRESS CITY ZIP PHONE <br />M�IL�DDRESS • C Y � �/- ZiP PNONE <br />a 5l �7 /zu.�xtr C{i�f. �c�-e✓t'.0 � ��G7 e253-45T; <br />r..wr+���w�wmnn�ivm m�iuvuneao arv ZIP PHONE <br />PLUMBINGCONTRALTOR MAILAD�RESS CITY ZIP PHONE <br />CLAS$ OF WORK <br />'�, �� NEW ��I ADDITION T ALTERATION � REPAIR DEMOLITION WOODSTOVE/FRPL INSERT <br />CONTACT PERSON AND PMONE NO <br />CONTRACT PRICE OF WORK �JmY�UX � a� UC/G� /� yy� �(���,, <br />DESCRIBE�` 'ORK AND SOUAR�E FO'O INV6L�ED / � <br />1n TGr/u�G 1I'��S , i2P,t✓ �lc�r� q7oZ <br />�nr <br />� PRQIECTADDRE55 <br />Z� <br />LCJQ� <br />J OF PROPERTV �SMOW N BELOW OF ATTpCH FOUR GOPIF.S� <br />BLOCK OF <br />a <br />NO. YYPE OF FIXT <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />�ISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN j � <br />BACKFLOW PREVENT <br />ROOF DRAIry3-RAINL <br />SINK ISERVICE—BAR. <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PEARSETBACK <br />�S n� <br />USEZONE LOTAREA <br />L-Z <br />TYPE Oi CONiS. ALLOWABIE <br />�— <br />SRE OF BLDG <br />/G-� 1.1 • <br />OCGUPANCYLOAD <br />�� <br />INTAKE BY <br />SUB TOTAL <br />PERMIT <br />IYPE OF CONSi. ACiVAI <br />FIRE SPRNNLERS REO'D <br />� <br />PLANS APPROVED BY <br />FEE <br />SI <br />STATE LIGENSE t <br />���l�� <br />STATE LILENSE s <br />R <br />BUILDING RELOCATION <br />� �-- % S?3 <br />i HEFEBY CERTIFY THAT 1 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 HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS 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 IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />st tin�unc � � �L � <br />LIIV BUSINE55 LICENSE NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />AIC—NHNDLG UKITS—H.P. ; j � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. �� <br />UNI7" HEATERS—B.T.U. M ' ; <br />CLOTHES DRYERS T <br />VENTILATION FAN � <br />RANGEHOOD T— <br />WATER HEATE7 � <br />WOOD STOVE ; <br />MEIAL FIREPLACE 8 CHIHINEV <br />FIREPLACE INSERT � ; <br />HEAT PUMP —�— <br />GAS PIPING � <br />EXHAUSTFAN / , <br />PLAN CHECK NUMBER <br />vncnNr sire FEES <br />�� eui�owc <br />occucnxcr xoormruuxscro�s <br />aoi� / <br />PLUMBING <br />BASEMEryT,o MECHANICAL <br />� <br />HEIGHTLIMITATI(;N ADDITIONALPLANCHECK <br />�5 SPRINKLER <br />STA7E BUILDING SURCHARGE <br />CITY UF EVERETf rueuc woaks <br />LOCAI SALES <br />TAX CUDE IS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT 5 <br />FEE <br />i�sr' S S� <br />—�— <br />�/i ;SD <br />