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APPLICATIOr�FOR CONSTRUCTI,N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PR�NT <br /> HEATING SYSTEM� GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 ! <br /> I I DEMOLITION COMBINATION BUILDING / MECHANICAI I PLUIiABING i i 81GN <br /> �p MAILADDRiSS CITV 21P PHON — <br /> T� ���0/�I3zL/.C.t��o Q-s� �'.rr7� 33�-&8'37� <br /> ���. Z�p VHONE <br /> TEN�NT M�ILADDRE55 <br /> �RCHITEGTORDESIGNER MAILADDRESS CITY ZIP PHONE <br /> GENER�ILCONTRACTOR MAIL�D�AE55 CIiY 21P PHONE STATELIGENSE• <br /> MELlUNICALCON CTOfl M�IL�ODPE55 CITY ZIP � PHONE� ST�TEUCJS�tn��� <br /> (0 <br /> %l7w� �/rl/!a/ <br /> LUMBING CONTRAGRIR MAIL ADORESS CITY ZIP PNONE STATE IIGENSE� <br /> C1A550F WORK <br /> I I NEW I 1 ADDITION ' �. ALTERATION . I REPAIR �� I DEMOLITION '. WOODSTOVE/FR4t INSERT I I BUILDING RELOCATION <br /> CONTRCTPERSON DP �. '� <br /> CANiMCT PP10E OF WORK / <br /> DESGR AND SOUARE POOTAGE INVMVED <br /> pppPp$E SEOFBU�LDING t • i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAtAE TO BE TflUE AND CORRECT.ALL <br /> �E(3AL pE$.^,qIPTION OF PROPERTY ISHOWN BEIOW OF AiTALH FWR CAPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLETED WITH WHETH�R SPECIFIED HEREIN OR <br /> �oT BiaK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT�AM AUTHORIZED BY THE <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 296.200 WAC. <br /> D� �r-�s-a� _,�yl�rL.�,/,��� �i/�f/93 <br /> S�GNAiUAE D�tE <br /> P ECT DRES <br /> We.�,N��r y cmeusmcssiKENSEuo <br /> PLUMSINO MECHANICAL , . <br /> ' TYPE OF flXTURE OR ITEM FEE NO. TYPE OF ECUIPMENT �E . -�,;;�� <br /> NO. � <br /> � WATER CLOSET(TOILET) � AIC—PJHNDLG UNITS—H.P. <br /> � BATHTUB ' FORCED AIF SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> ' SHOWER � CLOTHESDRYERS ' <br /> � KITCHEN SINK 6 DISP VENTILATION FAN � <br /> � DISHWASHER RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINIIL ' METAL FIREPIACE&CHIMNEY � <br /> DRINKING FOUNTAIN � FIPEPUCE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE--BAR,ETC.) ' <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> SUBTOTAL 5 ' SUBTOTAL S ' <br /> PERMIT $ PERMIT E <br /> TOTALFEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: aeceirr No. <br /> FRONTSETB�LK REARSETB�CN SIDESETBRCK PLpNCHEGNNUMBEN FEE <br /> USE20NE IOTAREA VACANTSITE <br /> FEES VAIUATION FEE <br /> BUILOING � <br /> 7VPEOFCONTS.PILOW�B.E ttPEOFCON57.ACTl1AL accuPw[r xoINmvEwMCUNrts � <br /> �"a'P � PLUMBING . _ ' <br /> ---�— <br /> SIZEOFBLDG. NOAFSTORIES BASEMENi MECHANICAL <br /> ADDITIONAL PLAN CHECK ' <br /> OCCUPANCYLO�O FIRESPRNKLERSREO'0 NEIGHTLIMITATION � <br /> SPRINKLER � <br /> FEASON FOfl SPRINKLEPS � <br /> STAiE BUILDI�•+SURCHARGE ' <br /> INT�KE BV PUNS APVROVEU BY CITY OF EVERETT PUBLIC WORNS � <br /> LOCAL SALES ; <br /> TAl(CODE IS 3/05 �TAL <br />