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APPLICATIO . FOR CONSTRUCTI� N PERlMIT � <br />TO BE COMPLETED IN BLACK INK–PLEASE PRINT <br />HEA�— TING SVSTEM: GAS �! ELECTRIC ❑ <br />BUILUING DEPARTMENT <br />259-8810 <br />DEMOLITION Ll COMBINATION '' BUILDING �ECHANICAL ' PLUMBING I I SIGN <br />OWNER MAILADORESS CrtY ZtP PNONE <br />5��� S79ce4 sJ8 We7�nc,ee .fk- �'uue{f 9E�oj, �s�-9s�8.t _ <br />TENAYT MAILADDRE55 GIiV ZIP PHONE <br />pRCNITECT OR UESIGNEF MAIL AODRESS dTY ZIP PYONE <br />GENERRL CONTRqCTOR AIqIL pD�RESS � ` CIN ZIP FNONE STAtE LICENSE • <br />�j 1 <br />MECNANICALCONTRACIOR MAILA�OPE55 <br />,.VtRGRiy�y Cs�a�i SUC�r__1�1e <br />PLUMBIN3 CONTRAGTOR MFtI ApORE55 <br />C�lTR�CT PRICE OF W09K <br />i�,; ' ao-o <br />DESCR BF WJRK ANQ SOUARE FWTAGE INVOLVE' <br />�� <br />'!F 9WlDING <br />LEGAL DESCP�PT10Y OF PROPI <br />LOT- BIOLK <br />PARCELTA%ID.NUM9ER <br />.S/�i S/� <br />PLUMBING <br />NO. � TVPE OF <br />DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />cirv nr .r�ryr ��,..�.,,.��...... <br />: d�i✓�t. �`�-uaw.+�` 98�� �s: 3��� E!/EXGSS/t <br />CITY ZIP PHONE STATEUCENSE• <br />GONTACi PERSON AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KIJOW THE SAME TO BE TRUE hND CORRECT. ALL <br />PfiOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />BELOWORATTACNTWO.OPIE51 WOfiK WILL BE COMPLcTED WITH WHF.THER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF P, ?ERMIT DOES NOT PFESUME TO GIVE <br />— oF - AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER STATE OR LJCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BY THE <br />OWNER OF THiS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />:LEPHONENUMBER x / / �J /� /.Y �_ /�_ �L/ <br />_ CYGY�v � �!//v <br />smn+nae � °"'� <br />_ ,�iyE arveusnessu�cNs� �,o -. <br />MECHANICAL <br />E OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />NC—AIH"IDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />. UNIT HEATERS—B.T.U. M _ <br />FOR OFFICE USc ONLY: <br />FRONT SETBACK fiEAR SETB/.CK <br />USEIONE LO1?REA <br />IYPi Of GONS7 NO OP STORIES <br />SIZEOFBLDG. fIFESPPINKLERSHC'L <br />OCGUPANGY LOPD FIFE AL�NM RE00 <br />REASON <br />INTANE DY <br />047E <br />�PPROVEOBV <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE �_ <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT _�_ <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN J <br />SIDESETBACN PLANCHECKNUMBER <br />� <br />vncaNr sire FEES <br />� YES ' ��� BUILDING <br />IXN��NLv NOO�DMFlli4GUH�15 <br />�°jp" PLUMBWG <br />Ba5E1AENT IdECHANICAL <br />�.�: YES :1�. NO <br />MEIGH" IIMIiAT!�1N ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILD�NG SURCHARGE <br />CITY OF EVERETT PUBI.IC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 T�TAL <br />ITAL 3 �JU ; � <br />f 5 <br />FEE 5 � <br />FF.E I AEC[IPTNO. <br />0 <br />