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i-Pr;i,:( A--PI-TT DUILDIIII; DFPT„l� TO: 7350113 Mj2R 14• 1991 1:02PM N275 P.02 <br />APPLICATION FOR CONSTRUCTION <br />TO BE COMPLETED IN INK —PLEASE PRINT <br />verett HEATING SYSTEM: ❑ GAS Q ELECTRIC J - <br />BUILDING DEPARTMENT - --- -- <br />259-8810 <br />PtRMIT eevereu <br />—� _—i <br />DEMOLITION ' COMBINATION BUILDING b�MECHANICAL PLUMBING <br />O'NNCq — UAII ADDRF55 CRY _ — --ZIP PHONE <br />3oGIIJ(a C immarcioA $y •40.22 c^3 Z""ol - —.. --- <br />itgnVT YI ,MYdLA0155[SS CITY 21P PNONF <br />1 1 SIGN <br />An: rtlC�T On D!$'CNtli MAR ADUnl SS CITY ZIP PHONE <br />C.FNFNAL CONIRACIUR MAIL AUURESS CITY ZIP PHONk LICEWFt <br />MCCI MICALC INTRAC.TOR IfIl AUORF.SS CITY ZIP PIIONF LICENSE <br />• <br />Fie< .sl< �[Jr✓' ._/�dZ�kF �_Ye%cl1, �,,6i%e,�� 9,�Y,r�i 83�-r7/f3 G•eG soli i ¢vBi <br />........................ .,.. .nnvn CITY ZIP PHONC LICENSkI <br />` CIASSOFWOAK �._. <br />NEW ADDITION ALTERATION ! REPAIR <br />I DEMOLITION : ' WOODSTOVETRPL INSERT f 1 BUILDING RELOCATION <br />CONTACI PER SON ANOPHONE440 <br />CNTAACT PRICE Or Y/OA`� <br />CK i5z, <br />00 ___.....\�/tvm/•.6!/4�4 <br />zar <br />Zyld� <br />Ut V;HItlLW(NIKANLIVJVA"t FOOIAU INVLAVLU <br />62E .�ei,�/�l�Es i,t/ .UFet _ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />cR:�a05Fn u5c DFR ur, <br />,,cfA/4atvr r%Gl!GTrj <br />DCSC.RIPiION CX PRODCRTY 1S40WN W.lOA OR ATTACH FOUR COPIEFI <br />PROVISIONS LAWS AND NANCES SPECIJaTHIS TYPE OF <br />WWILL BECOMPLETEDWTIH WHETHER ED HEREIN OR <br />I L•1 BLOCK eF <br />NOT. THE GR.ANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />..... --- <br />y' <br />AUTHORITY TO VIOLATE OR CANCEL 7HC• PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CDNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />+ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 290,200 WAC. <br />SIGNAT OF T IOBOHtM [ZED AT RAIE <br />-----..__�_•—?.I�/GI/IJ <br />IIiiZ y-L2____�_(�� <br />rIYJJtCI AUUHtSS <br />APPLICANTS CITY BI ISINFBS I ICENSE NO AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO, <br />TYPE OF ECUIPMENT <br />FEE <br />WATER CLOSET_ (101LET( <br />A'C—XIHNDLO UNITS—H P. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />T <br />' <br />_ <br />BATHTUB <br />LAVATORY (WASH OASIN( ---.._ <br />_ <br />.._.. <br />UNIT HEATERS—B_1'.U. M <br />.—-•T--- <br />_ <br />! <br />SHOWER <br />KITCHEN SINi(i DISP <br />CLOTHES DRYERS <br />VENTILATION FAN <br />i <br />; <br />DISHWASHER _ <br />LAUNDRY TRAY <br />— <br />RANGE HOOD <br />_ <br />WATER HEATER <br />- <br />CLOTHES WASHER______ <br />I <br />WOOD STOVE _ <br />' <br />URINAL <br />METAL FIREPLACE & CHIMNE•r <br />! <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT <br />DRAIN ---------- <br />HEAT PUMP <br />__FLOOR <br />BACKFLOW PREVENTERS <br />' <br />OAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN - - <br />SINK (SERVICE -BAR. ETC) <br />-7 <br />SUBTOTAL $ <br />SUB TOTAL 6 <br />PERMIT 5 <br />PERMIT $ <br />TOTAL FEE 6 <br />I <br />TOTAL FEE S <br />' <br />DOR OFFICE USE <br />TONT SETBACK <br />ryt ZONE - <br />�Ir OI Cows A.tLWAFu <br />•ZCOrwn6 <br />ONLY: _ <br />SIDE SETBACK PWI CHECK Id <br />HtAH StTSACK <br />LOT AREA <br />ivn or r:ovsT.-AC1uN <br />VACANT SITE <br />FEI <br />BUILDING <br />ar•.vAK+ <br />j1�•r <br />A9 aCN;,u•W uri <br />PLUMBING <br />NU OF S10Nh5 <br />BASEMLNT <br />MECHANICAL <br />GCUPANCY LOAD ME <br />CASON rOR EPRIN+IkHS <br />�,Kt Br oinl <br />1� <br />ADDITIONAL PLAN CHLCK <br />OTHER <br />STATE BUILDING SURCHARGE <br />• <br />OF EVERETT PUBLIC WORKS <br />+M c 1 re -- <br />;7;7 <br />