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0 <br />APPLICATIt�.� �OR CONSiRUC7.ON PERMIT � <br />TO BE COIAPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT r HEATING SYSTEM: v GAS ❑ ELECTRIC ❑_ <br />259-8810 <br />DEMOLITION COMBINATIUN BUILDING MECHANICAL PLUMBING SIGN <br />011NER / MF�LADDRESS CITv ZiP PHONE <br />:�/l.LYioA7esN C�„)�l,^J ��1.% n� I'�7r l�:. rL,-. /"',.:_�a.�.-. I Il.Q <br />� � <br />>rJo ,�.y?�.�n C �+✓n.>Y � .� r�.U. l <br />V[RiLCON7FACTOR MAILADDR[55 I / <br />:('�//i_— /��1�4)c71i �1�'� �1�1 <br />]NANICALCONT9ACTOR MAILADDRESS <br />,L�iP <br />INBINGCONTRFCTOR AIAILA�DRESS <br />n�'./A <br />CLAtiS OF WORN <br />' NEW � ' ADDITION , ALTERATION <br />CONiRACTPRICEOFWORR "�� <br />DESCRIBE WOP.K AND SOUARE POOiAGE INVOLVED <br />=X[rt.i��r�nJ Diti OR�✓„�r. �'l.�F.-,z�, <br />PNOPOSEDUSE�OFBUILOING � <br />�ir. �m <br />�i1C7t.'ti� �1.�1- <br />CITY � :IP <br />GTV Z�p <br />CITV TIP <br />GTY IIP <br />Y�1VIV[ <br />PHONE ST�TELICENSE• <br />PHONE STATE UCENSEa <br />PHONE STqTEtILENS[� <br />REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCAT,ON <br />CONiaCT PERSON AND PMONE NL <br />� ,S�c�r—`"SJicn,-y� ./Nr —��c�n�..- <br />LEGAL DESCRIPTION OF PROPEFiV (SHOWN OEL01Y OR ATTACN FOUR COPIP.S� <br />LOT BLOCK qF <br />PROJ TADOPE55 <br />��o a cv t/yja�+,� (% � <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />\NATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) _ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRI'TRAY <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PqEVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />PERMiT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN FEARSETBACK <br />USE20NE LOTAREA <br />TYPFOFWNiS.ALIOWABLE iYfFOFLOMSi.ALTUAL <br />SIZE OF BLDG. NO. OP STORIES <br />OCCUPANGV LOA� FIRE SPRNKLERS REO'0 <br />REASpN FOR SPRINY,LERS <br />INTAKEBY PlANS. Pfr1lGDBY <br />FEE <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAM'c TO BE TRUE AND COHREC��. ALL <br />PROVISIONS OF L/1WS AND ORDINANCES GOVERNING THIS Tl'PE OF <br />'NORK WILL BE COMPLETEU WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PR�SUME TO GIVE <br />AUTHOFITY TO VIULATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH'c <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORV.ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TH[ WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW t8.27 RCW AND 296.200 WAC. <br />x L "- l'� � �_ >-r--' -�'/ 3//l'� <br />SIGNAfUF[ Dntf <br />CILY BUSIFESS lIC(NSE NO <br />MECHANICAL <br />NO. TVPE OF EOUIPMENT FEE <br />AiC—A�HNDLG UNITS—H.P. <br />FORCED AIR gySTEMS—B.T.U. M E.A. —�— <br />UNIT HEATEHS—B.T.U. M <br />CLOTHES DRYERS � <br />VENTILATION FAN � <br />RANGEHOOD <br />WATER HEATER � <br />WOOD STOVE ; <br />METAL FIREPLACE 8 CHIMNEY � <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />� <br />GAS PIPING � <br />EXHAUSTFAN , <br />SI�ESETBRGK PLANCMECK IBEfI <br />3s "�a/ <br />VACANTSRE FEES <br />BUILDING <br />acue.v;. r,oacm�uuxr.er�rs <br />�pDLP PLUMBING <br />BASEMENT h1ECHANICAL <br />MEIGMT LIMITATION ADDI710NAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDIN3 SURCHARGE <br />CITI' OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TG fAL 8 <br />PERMIT $ <br />TOTAL FEE $ ! <br />REChIPi NO <br />� '.7 <br />�� � _,L <br />i <br />T <br />j � 3U <br />