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: � APPLICATI�"'Y FOR CONSTRUCT'��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �!+� <br />k,4 .� <br />; �;' _ <br />� - <br />r-_,;� �.:'. <br />r'.:.. <br />a � � <br />y � <br />H�N <br />IQ � <br />� � � <br />V. H <br />�O� <br />OH(y <br />Q�C] <br />ry�N <br />g�°H <br />��� <br />�� <br />� <br />1 C, <br />V <br />� <br />f HEATING SYSTEM: J GAS �ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION k BUILDING ,� MECHANICAL � PLUMBING SIGN <br />�WG�'rTcf/ ,�J6p�L S"�4�Nc✓ ��Z !+� %��� 5z6-L�-9� <br />TEN4Ni / I.IqILRDORE55 LIIY ZIP f'HONE <br />'` q - <br />RRCNRECTORD[SGNER MARpDORESS CIiV Z�P P��ONE <br />�4 ¢ 33y-t�5� <br />GENER C fCTOP MAILADOF[SS Cii' T PHONE StATELiCENSE• <br />T2.ibti"/ C att�. � �• �� �69 M4 ��1eo %�'Z�S 353"3�� ?�6ti �/7G7� <br />hf[C�NNICALWqiFACTOR M1UiLAOpBESS Cirv 2iP PNONE STATELICENSE/ <br />PWM1iOiNGCONTRAGTOR MAIIA[JORESS CiTv T6' PIIONE STATEUGENSE• <br />CLRSSOF WORK <br />�( NEW � ADDITION ALTERATION REPAIR <br />�i.�a-�/'r.w & 7t� %Yo � <br />CONTRRCi PRiCE OF WORK <br />DESCRiBE 1YORK RNp SOIIARE FOOtAGE INVC:V[D <br />r. �� .� •. .e. /'e ZD <br />LEGAL DESCRiPT10N OF PROPE <br />�OT__� BIOCN <br />DEMOLITION <br />I co�rncr <br />� '�"ti�� �-CJ%�-u.�i/4� <br />]lYNO[L01Y TTACIIFQb�SCOPIE51 <br />r <br />OF ��.b /?n 2 �.%/- % / <br />✓ 7,� 3 C�.x..t �r. <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET(TOILET) �!I <br />BATHTUB � -- � <br />LAVATORY ( WASH BASM) 1 � <br />�_ SHOWER J � <br />/ kITCHEN SINK 8 DISP I <br />DISHWASHER � <br />/ LAUNDRVTRAY I <br />CLOTHES WASHER <br />UFiINAL <br />DPINKING FOUNTAIN <br />Fl OOR DRAIN <br />BF.CKFLOW PREVEIJTERS <br />FOOF ORAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 _�/�. <br />PERMIT S <br />FOR OFFICE USE ONLI': <br />�-�ONi SETOALN REAH SEi9AGN � SIpE <br />/1 I � -f if <br />USE TOY.E <br />/� _/ <br />iYFEO�f WJ'NtS AIIOWABIC <br />�% �—_l___ <br />SIZE OF 13LDG <br />14�I sr � <br />y;9 sf GaR <br />OCCUPrVICY LOAp <br />r.✓n <br />REASONFOR.�,PPINNLERS <br />iMrnn[ ev <br />LVPIOFLONSLACipAI ncc;:wCr <br />pie <br />NOOF90P 5 BA',�tAENT <br />Z <br />FlRE SFRHHI Efl5 FEOD HEIGHT I.iN <br />HO Of pM W MG ONi�S <br />� <br />CITY OF EVERETT <br />LOCALSALES <br />TAX COOE IS 3105 <br />1VOODSTOVE'FRPL INSERT BUILDING RELOCATION <br />3s3- 31r� <br />� HEREBY CERTIFY THAT I HAVE READ ,1ND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORH 6VILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TI{E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV 10 VIOL�TE OR CANCEL THE PROVISIONS OF ANV <br />OTHER S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE JF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI� PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS M E AND I CGMPLY WITH THE STATE <br />CONTRACTORS LAW 1 2 RCW ND 296200 WAC. <br />�' �., , _ i,/�ol�v <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS I <br />VENTILATION F�N <br />IVATER HEATER <br />MBTAL FIREPLACE 8 CHIMNEY I . S� P� <br />HEAT PUMP <br />E%HAUST <br />PLANCHECKNUMBER <br />� _ 3s�.� <br />ew�oirvc <br />PLUIdBING <br />t.tECHAI llCAI <br />ADDITVONAL PLAN CHECK <br />���� <br />STATE PUILDMG Sl1RCHARGE <br />PUPLIC WOFKS <br />70TAL <br />FE[ <br />33� <br />5� <br />i[CEIPi NO. <br />7vv �a <br />FEE <br />�T <br />_ �� ' <br />�� <br />� <br />i <br />/0 ; — <br />� SG <br />/� � � <br />� <br />_. . —, — <br />