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APPLICATIOL FQR C�nIST�IlC°T�` Id PEF�r:91T <br /> TO B'c COMPLET�_D IN B�ACK IMK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC � <br /> 259-887� <br /> I 1 DEh10'_I�ION I 1 COMBINATION X BUILDING I I MECHANICAL ! I PLUMBING I I SIGN <br /> OWNER �dAILADDPESS GITY ZIP P��ONE <br /> �� �am�-� 3J.y o EA�T��iKF Au� F S.eotN� G�� 9�io,z =s��-�3� 7 0 <br /> TEN�NT MAIiAOUflESS CIN ZIP PHONE <br /> ARCHI7ECTOflDE51GNEfi MAILA�DRE55 CITY 21P PHONE <br /> GENEFALCONTRACTOfl MAIL%�OORf55 GTV ZIP PHONE STAIEUGENSEY <br /> SA�'1'1� A s �Ju>iu�.t' _ 1�i9«r H= i� o �- 7 <br /> MECMRNICAL GONTR�CTOF MAIL A�DRESS CITY ZIP PHONE STATE LICENSE a <br /> PWAIBINGCONTRACTOli MAILAODflE55 GTY 21P P��ONE STATELICE�ISEi <br /> CLASS OF WORK <br /> �NEW I I ADDITION I I ALTERATION i i REPAIR I I DEMOLITION I I WOO�STOVEIFRPUNSERT � i BUILDINGRELOCATION <br /> CONTACT�AE.fRSON AND PNON3 NO. ^ Q p n <br /> CONTRAGTPRICEOFYJORK SLC// �ALT��� �`S�� /DJJ' <br /> DCSCRIBEWOFiKAND50UAREFOOTF NtlC n S� <br /> PFO OSEDUSEOFBU/ILDI�NG / �! a �a�3 ��T 01 H R BY CERTiFY THAT I H�AVE R D AND EXAM NED TOHIS <br /> S//1�I�P 1—//�'�/� —Q�-��-P/'IG� AFPLiCATItIN P.WD KNOW THE SAME TC i=E TRUE AND CORRECT.ALL I <br /> LEGALD CR:PTIONOFPROPERT (SHOWNBELOWORATTACHFOURCOPIES) PROVISIONSUFLAWSANDORDINANCESGOVERNINGTHISTYPEGF � <br /> r� WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> �or� d n�ocK oF i II/ w� � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIVE <br /> AUTHORITY TG VIOLATE OR CANCEL THE PRUVISIONS OF ANY <br /> ��� �f OTHER STATE OR LOCAL LAW FEGULATiNG CONSTRUCTION OR ^I� ' <br /> PERPORMAiJCE OF CONSTRUC�ION.THAT I AM 4UTHORIZED BY THE <br /> OWNER OF 1'HIS PROPERiY l0 PERFORM THc WORK FOR WHICH <br /> APPI.ICATION IS MADF. AND I COMPLY WITH THE STATE <br /> CON'�,'RACTORS lAW 18.27 RCW AND 296.200 WAC. <br /> X � – � � d��— <br /> PPOJEGT AOOPESS Sauni DniE <br /> 8�S L�Q � P/(�G� cirv usrt+[;5 uceuse rvo <br /> FLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUflE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FOHCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION F/1N _ __I_ <br /> DISHWASHER � RANGE HOOD _ � <br /> LAUNDRY TRAY ; WATER HEATeR ' <br /> � <br /> CLOTHES WASHER � WOOD STOVE _�_ <br /> URiNAL ; METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUPJTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � <br /> FOOF DRAINS—RAINLEADERS � EXH�UST FAN ' <br /> SINK(SERVICE-9AR,ETC.) � � <br /> — � ' <br /> � ' <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SU8 TO fAL $ _ ; <br /> PERMIT 5 � PERMIT $ � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOf! OFFICE USE ONLY: <br /> FRONTSEI��CH REAR��C�$.��� SIOESETBACK� / PLANCHE�GKNUM� FEE REGEIP(NJ. <br /> ZO � � %!i' q 3c� c��-3 <br /> � <br /> usezor+e �OTAREA q /� VACANTSITE FEES VALUATION FEE <br /> 77i/ �J BUILDING (� � // �/ '�J(_ <br /> iYPE0fC01115.AlLOWABIE iYVEOFGONSi.AC7UAL aturu¢v rvoorownuuGUHnS — � <br /> fy"0°v PLUMBING '"� <br /> �/ K ' � — i <br /> SIZEOFO�DG NO.OFSTORIES OASEh1ENT MECHA�JI:AL r <br /> 23io SF T p � <br /> 6"7E� SF- G02 � qDDITIONALPLANCHF.CK � <br /> OCCUPANCY IOAD FIRE SPRNKLERS REO'D N21GHT LIMITATION <br /> A /� Z`3" � s�d��a- ' �. ' � •- <br /> PEASON FO SPRINKLERS � � I i�C <br /> S7ATE BUILDING SURCHARGE -f <br /> INiAKEBY PLANSAPPROVE09Y CITY OF EVERETT PUBLIC WOF7KS / � <br /> J I� Tti?(CO�E SL3105 TOTAL <br />, <br /> i2/„ y3 73 �C <br />� ____ �� ` <br />