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APPLICATIC�1 FOR CONSTRUCT'-1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: <br />259-8810 <br />DEMOLITION I , COMBINATION <br />OWN[F IA�ILAD�FESS <br />� <br />J'-�l��,j-r',- l ,�r � - ���'):1;; � <br />TENANT MFIL�GDRE55 <br />AliCHITECTOR0E51GNER lA41LADDRE55 <br />GENEFALCONTPACTOR MAI:ADDRESS <br />IdECHANICAL GONTRACTOR M�IL A�ORESS <br />NLI� l-1�,1-F:�f I�': ��-° f- �II(� hl� I I flU <br />PWId81NGCONTR�CTOF MAl1.AD�RE55 <br />CQNTRACT PRICE OF WOR!� <br />��LCC .��L <br />� <br />�ESCRIBE WORK ANDSOUARE FOOTAGE INVOLVED <br />' BUILDING <br />CITY <br />� /i. _ I�) <br />��•.7n_IJ r..c• I-:.;i�nr.: li_Gi-t!. li.�,�-. <br />PROPOSED USE OF BUIL�ING <br />� F f'Z <br />LEGFL �ESCRIPTION OF PHOPERTI' (SHOWN BELOW OR ATTACH TWO COPIES� <br />LOi OLOCN OF <br />� Pi�� AX��NUW�—OI�' <br />C <br />GONSTPUCTIONLOANLENDER,AODRESS <br />PROJECTADDRESS <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWA3HER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RA W LEAC <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FqON75ETeFGN REARSETBACK <br />USEZONE LOTAPPA <br />TYPEOFC01l57. NO.OfSTORIES <br />SIZE OF BLUG. FIRE SPRINK�ERS PEO'D <br />OCCUP�NCYLOAO FIqEALARh1REOD <br />REASON <br />INTAKE DY P�ANS APPROVED BY <br />DATE <br />CITV <br />CITY <br />CIiY <br />GTV <br />FEE <br />� <br />0 <br />U ELECTRIC ❑ <br />��! k(ECHANICAI <br />Z�P PMONE <br />�l!/l `�Gl/J', ia <br />2�P PMONE <br />ZiP PHONE <br />I�P PHONE <br />ZIP PMONE <br />� <br />_,..� � ��.�.�, J <br />Z�P PNONE <br />WNTACT PERSON AND PHONE NO, <br />i ' PLUMBING iJ SIGN <br />;-� '� I'�- \����71� <br />STFTE IICENSE M <br />STATE LICENSE p <br />�- r,: �� N iv,4 /�. 3 <br />STATE LICENSE n <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICA?ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITFi WHETHER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUIHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 IS MADE AND I COMPLY WITH ?HE STATE <br />CONTRACTOiiS LAW 18.27 RCW AND 296200 WAC. <br />��Yni��M.��� �J��., =,1,��1��� <br />A/G—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />flANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETBACK PLANCHECKNUMBER FEE <br />VACANT SITE PEES <br />❑ YES �7 NO <br />BUILDING <br />acwnxcr r;aa�ow�wnr.uwrs <br />caoua pLUMBING <br />BnSEMENT MECHANICAL '^ � <br />i= YES G NO <br />HEIGHTLIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT pIIBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />M E.A. <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />RECEIPT NO. <br />N <br />�p <br />n <br />� <br />d <br />0 <br />