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AF�PLICATItir�l FOR CONSTRUCI .ON PERMIT <br /> TO BE�OMPLETED IN BLACK INK—PLEASE PRINT �ri <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ❑ELECTRIC O _ <br /> 259-8810 <br /> C:l DEMOLITION L i COMBINATION i_i BUILDING [ J MECHANICAL QCpLUMBING ❑ SIGN <br /> O R 2 ,� MA ADDRESS CI ZIP PHONE <br /> a �i,� / J�K� �Gr � 9 b�� �c*� �Z SO �SL - Z47� <br /> TENAHT MAILADDRESS CITV ZIP PXONE <br /> APCHR Ofl SICNEi MAILADORESS CIN ZIP PHONF <br /> �r�.- c� •�/0 3 �rO 9YzSo �4�/��� r� i �F <br /> GENERALCONTF�CRIR MAILRDDRlSS CITV ZIP PHONE STATELICENSEM <br /> MECCANICALCONTRACTOR MAILADDRE55 CITY ZIP PMONE STATEUCENSEi <br /> �� ` <br /> � UMBING CONTMCTOR MRIL ES CITV 21P PHONE STATE UCENSE N <br /> Q�s -�'rtiui� lrG� 3Y!l�!'k,dYrTci Cr�� �gLv/ 1-5��o ��i�s�a <br /> cwss oF woRK <br /> � � ❑ NEW CI .4DDITIUN ❑ ALTEflATION I i REPAIR : I DEMOLI"ON ! I WOODSTOVE/FRPL INSERI L i BUILD�NG RELOCATION <br /> . CONTACT PERSON AND PHONE NO. <br /> �� . CONTMCT PRICE Of WORN <br /> � DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br /> � PflOfOSEDUSEOFBUI�DING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � "� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �I LEGAL DESCRIPTION OF PROPERTV(SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ' WORK WILL BE COMPLFTED WITH WHETHER SPECIFIED HERE;N OR <br /> . �or BLOCK oF NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � � OTHER STATE OR LOCAL LAW PEGULATING CONSTRUCTION OR THE <br /> � : PERFORMANCE OF CONSTFiUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PEfiFORM THE WORK FOR WHICH <br /> � � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � � CONTRACTORS LAW 18.27 FCW AND 296200 WAC. <br /> ' I <br /> i X��, ������.� r 2 <br /> PRO.IECTAODflESS <br /> � �` � CITYBUSINE59lICEN5EN0. <br /> ' P�UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE 09 ITEM FEE NO. TYPE UP EOUIPMENT FF.E <br /> WATER CLOSET(TOILET) � A/�A/HNDLG UNITS—H.P. � <br /> �— <br /> BATHTUB ; � FORCEDAIRSYSTEMS—B.T.U. M E.A. y_ <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> - SHOWER �' CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> � 1'RINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PU�AP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DFiAINS—RAINLEADERS � EXHAUST FAN � i <br /> SINK(SERVIC�i—BAR,ETC.) ; � � <br /> � I <br /> ' ' I <br /> � � <br /> i � <br />� SUB TOTAL $ ; SUB TOTAL $ ' �� <br />� PERMIT $ � PERMIT $ 1 ''� <br /> �� TOTAL FEE $ O ' � TOTAL FEE $ ' ' <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK REARSETBACK SIDESETBRCK PLANCNECKNU/M�BER fEE RECEIPTNO. �I <br /> L� <br /> USEZONE LOTAPEA VACANTSITE FEES VALUATION FEE '� <br /> i <br /> BUILDING • ' ', <br /> ttPEOFCONTS.RILOWABLE ttPE0FWN5T.ACi�AL occuru+Cv xocrownuxsuxits i �� <br />� tnouv ' PLUMBINCa i — <br /> SIZE OF BLUG. No.OF S7oRIES BASEMENT MECHANICAL ' <br /> OCCUPANCV LOAD FIqE SPRNKLERS REO'D HEIGHT LIMITATION ADDITIONAL PLAN GHECK i <br /> i <br /> SPRINKLER � <br /> REASON FON SPRINKLERS i �, <br /> STATE BUILOING SURCH4RGE � <br /> INTAKE9V PLANSAPPROVEDBY ' <br /> CITY Of EVERETT PUBLIC WORKS � <br /> LOCALSALES � <br /> TAX CODE IS 3105 TOTAL ; <br />