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APPLICAT�OI _ FOR CONSTRUCTI"N PERMIT� <br />TO BE COMPLETED IN BLACK INK—Pl EASE PRINT `�;,/��. <br />�-J_.. <br />HEATING SYS <br />BUILDING DEPARTMENT TEM. V GAS ❑ ELECrRIC ❑ <br />259•8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL p�PLUMBING SIGN <br />OWNER MAILADORESS CI7V ZIP PHONE <br />����iAG✓ /�P- .�O�C �5�1 �veiaP^- `�1r��6 '7�1�-/��� <br />TENFNT Q�� MAILADDRESS qTY ZIP PNONE <br />Mk) <br />ARCHITECTORDEuIGNER R1qILpDDRESS CITY ZIP PMONE <br />��,! P�BPe,eT'ie.s Pollox �rs� �,x,ot;,- 9�ao6 �s. a-�7.i� <br />GENERALCONTRAGJR MMLADDRE55 CRV ZIP PHONE STATELICENSE� <br />MECNANICAI CONTRACTOR MAIL AODRESS CITV ZIP NHONE STATE LICENSE • <br />�Jon P.tuo,�l.,n �'7 S� �'t�en��--r�.�[L u�n Eve.�.:. 9'�..7�o,f <br />PLUMBING C011TRACTOR MAIL AtlBIiESS QiY IIP PHONE STATE LICENSE a <br />�n a` ,�ol�;.� P .� 7» J <br />NEW I I ADDITION <br />OESCPIBE WORN RND SOUARE FOOTAGE <br />, P/...- .,- - <br />ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDINC RELOCATION <br />CONTAC f PERSJN AND PHONE N0. <br />,�S !o y� I 77'/i.t'c _r%�en �r s'S.f 6/ �/ <br />uvnivvn � <br />PFOPOSED USE OF QOROING <br />/gPT <br />LEGAL DESCRIPTION OF PROPERN �SHOWN BELO' <br />LOT BLOCK OF <br />�3� �0�.!!�Cec <br />PR0.IECT ADDRESS <br />PLUMBING <br />NO. TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />/ BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />� DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR ETC.I <br />FOIIR COPIES� <br />3 <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBFGK dEqRSETBACN <br />USEZONE LOTAREA <br />7VPEOFCONB.AIIOWABIt iYPEOiCONSiACiUAL <br />SIZEOFBIDG. NO.OFSTORIES <br />OLCIIPFNCYLOAD FIRESPRNKLEBSREOD <br />INTAKE �Y � f`LANS APPROVED BV <br />S�DE SETBACN <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED TFIIS <br />APPLICRTION AND KNOW THE SAME TO BE TRUE ANO 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 />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF APIY <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 I COMPLY WI7H THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x %�%.c��-� � �saq- �� <br />s��n1��Ae onr� <br />QIY pp5ME55 LICf R5E NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/C—A�HNDLG UNITS—H.P. <br />FORCFD AIR SYSTEh1S-9.T.U. M E.A. <br />UNIT HEATERS—B.T.U. Id ; <br />CLOTHES DRYERS <br />VENTILhi ION FAN <br />RANGEHOOD <br />WATER HEATER � <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV � <br />FIREPLACE INSERT ' <br />HEATPUMP , <br />GAS PIPING <br />EXHAUSTFAN , <br />PLANGNEGKNUTABER I FEE <br />BUILDING <br />acuv>y�r xnorm�iwvcvxrts <br />caouv - PLUMBING <br />BASEMENT MECHANICAL <br />'�EIGHT LIMIIATION ADDITIONAL PLAM CHECK <br />SPqINKLER <br />STAiE BUILDING Sl1F'CHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />N0. <br />8y <br />N <br />