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APPLICATIQS' FOR CONSTRUCT! �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM� J GAS 'J ELECTRIC <br />BUILDING DEPARTMENT J —_— <br />259-8810 <br />OEMOLITION COMBINATION BUILUING <br />���V(�����R ldAit AODR(E�55 CiTY <br />lEN—i�-Nt1'�f`�-11�...��-1-7-111—��L�Q�iC� .�. 1 _ <br />ld�IL ADDti[55 CrtY <br />AliCN17ELTOf DESIGNER MPILADDRE55 GTV <br />,G/�ENE(R'�ALCONTR4CTOR MAILAODRE55 CITY <br />!d-CHANICpLC� �Cl R MAILADORE55 CiTY <br />1 � I1 � <br />;%� u��n� l,r) 1 �1 �� �`Q ��� � k �c �� h�� <br />PIUMpING NiRACtOR M�II �DDRE55 � CITY <br />.!� . �� . 1 <br />CONiiiFCt PRICE OFIVORK -� <br />�[SCFIBG W05K 4N0 SOUFRE FJOTpGE INVOLVED <br />PPOPOSED OSE OF BIIIIDING <br />LEGAL DESCRIPiION OF PROPEfitV �SHOLVN BELOW OR ATTACH T1Y0 COPIE51 <br />l0T BLOCK OF <br />PARCELTA%ID 1JUTAPER <br />CONSiRUCT104L04NtEN�ER.�GDRE55.TELEPHONENIIM�ER <br />PROJECTADDRES <br />��o� � a-E�_ <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN7ERS <br />ROOF DR41NS—RAINLEADERS <br />SINK 1SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACF PE/+RSET9ACH <br />US[ ZONE LOi �FErI <br />IVPE Of LONSi. <br />SIZE OF �LDG. <br />OCCUPANCYLOAD <br />REASON <br />IRi�KE �Y <br />I[�]!d� <br />FlqE SPRINKlERS REO'D <br />FlRE AIAHId REO D <br />ninns rr��noveo ov <br />DATE <br />AIECHANICAL <br />LP PHpNE <br />ZIP VI.ONE <br />21P f'HONE <br />21P PMONE <br />ZIV PHONE <br />��� `�— <br />ZIP PHONE <br />CONTACT PERSON AND P�iONE NO <br />/CPLUMBING <br />UCENSEx <br />LILENSE � <br />SIGN <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COP,RECT. ALL <br />PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK VJILL 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 PROVI;;IONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUC f ION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM Al'THORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORI; FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 flCW AND 296.200 WAC. <br />A�C—A:HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />� WFT[R HEATER <br />� WOUD STOVE <br />i METAL FIREPLACE (WOOD BURNING) <br />FIREPIACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />� E%fiAUST FAN <br />SIDESETBACN PLAIICHECHry�ApCf� f[[ <br />/� �/� <br />7 �� <br />vncnvt sire FEES <br />�. YES f5 ND BUiLDiNG <br />eceueu,cv rmo�ownuetumrs <br />c�ou� p�UMBING <br />oASEMENT MECHANICAL <br />' '. YES � : NO <br />HFiGNi uMiTATioN �DDI110NAL PLAN CHECK <br />OTHER <br />STATE �UILDING SURCHAHG[ <br />CITY OF EVERETT ruouc woares <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />J ' <br />FEE <br />—� <br />N <br />