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•• '� APPLICATIG J FOR CONSTRUCT JN PERMIT everett <br />,�,, TO BE COMPLETED IN INK—PLEASE PRINT � <br />rne �F <br />�vereti HEATING SYSTEM: GAS U ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />�l DEMALITION � i COMBINA'i"ION BUILDING C:, MECHANICAL ' 7 PLUMBING fl SIGN <br />OWNE M�ILADDflE55 -- CITV 21P PHONE <br />Wc.C� <br />�Cfl �ooAEt� 2ooi� i2*Hq� NE SF..,F-rr�� wk 98iS� sy6-z`i9 <br />TENANT MAILADDRESS CITY ZIP PNONE <br />�SIGI� �N so L T�d?S Po. �ac + 3ob �u Ic:1`f'Fo w<► `t8 2`]s <br />AflCNITECTORDESIGNER MAILADDFESS CITV ZIP PHONE <br />GENE{ULCIXJTR4CTOR MAILADDRE55 CITV ZIP PHONE LICENSE/ <br />QW ��� <br />MECH�NICAL CONTRACTOR MRIL ADDRE55 CITV ZIP PHONE LICEqSE 1 <br />�P- SMBINGCIXJTRACTOR MAILADDRE55 <br />i- � <br />WOfiK <br />. NEW G ADDITION ❑ ALTERATION <br />�CONTMC PRICEOFWORK �� ��yL/ �� <br />DESCRIBE WORK RND SOUARE FOOTRGE INVOLYED <br />y3�6 _ _ <br />PROPOSED USE OF BUILDING <br />S�i�-�� F� � �'� <br />LE L DESCHIPTION OP PROPERiV (SXOWN BEIOW OB r1TT <br />10T�_ BLOCK �_ OF �iC <br />� <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�RAINLEAO <br />SINK (SERVICE—BAR, ETC <br />CITY <br />ZIP PMONE LICENSE t <br />CJ REPAIR � 1 DEMOLITION C.! PlOt7DSTOVE/FRPL INSERT u BUILDING RELOCATION <br />�CONTACT PERSON AN� PHONE NO. <br />I ioDD M �N000� t� w"R-Y, syb- zyG I <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FPONTSETBACK � REARSETBACN <br />� <br />USE 2 LOT AflEA <br />"s ~ �� <br />TVPEOfCONTS.pLLOWABLE iVPEO:CG i.RLTIIAL <br />SIZEOFBLW. NO.OFSTOflIES <br />OCCUPANCY <br />i <br />INTANE BY <br />��S APP OVED BY <br />2! 3 � <br />� 1 <br />FEE <br />T <br />_ <br />�� <br />T <br />—� <br />i. <br />i <br />T <br />,_ <br />� <br />-T <br />I HEREBY CERTiFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPF OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER611T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTOR W 1827 RCW AND 296200 WAC. <br />SIGNATURE� �TRACTORORAUTHORIZEOAGENT DATE '%-/G'f� <br />APPIjCANTS GiY BUSME55 UCERS�NO. AND BUSINE55 NAME <br />MECHANICAL <br />N0. TYPE OF EQUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR S`.'STEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN <br />1 RANGEHOOD <br />1 WATEfi HEATER <br />I WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />L GAS PIPING <br />. � EXHAUST FAN <br />SIDE SET9AGK � PLAN CNECK NUMBER <br />75 <br />VACANT5IT � FEES <br />BUILDING <br />OCCUV�NCv NO OfpNFIIIXGUNIiS <br />GPOUP � pLUMBING <br />-3 <br />BASEMENT MECHANICAL <br />� <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />_ , OTHER �� <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCALSALES <br />TAX CODE iS 3105 70TAL <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAL FEE $ <br />FEE FECEIPTNO. <br />Ss�.Gp �/7.3 <br />VALUATION FEE <br />3 2' <br />29%/�lC� ��%D � <br />J <br />