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APPLICATIC i FOR CONSTRUC'�JN PERMIT <br />TO BE COMPLETEU IN BLACK INK-PLEASE PRINT � <br />BUILDING DEPARTMENT ��ATING SYSTEM: lJ GAS ❑ ELECTRIC [J <br />259-8810 <br />DEMOLITION I I COMBINATION BUILDING '�IECHANICAL i I PLUMBING ' SIGN <br />OWNF.R IAAILADDRESSA �.�y{- GItY ZIP PHONE /�/� <br />tFN�✓�i:]��in:�OREING[/ i%v1.��� GI�� �7� Q�7!/� II//CJ <br />� ��`�!'� _"_ __ <br />��CHIIECIORIESIGIlER MNLADDRE55 Cllv 71P PNONE <br />�-�+� _ �+��Nd�_4?�1� � �v����?epo� 1�'0/2�►-�� � �1.�8 <br />f.FNF M. C011104 iOR 1AML AODHE S CIIv 71P PUONE ST403 UC6VSG t <br />l �rP� u),��. V�ll�a-� <br />M�II <br />PLUMBINGCON7P.�CTOR MAILAUDPE55 <br />7.IP PIIONE ST47ELICENSC• <br />G1A550f WOfiK <br />I I NEW '%'� ADDITION I! AlTE:9ATION �'�� REPAIR i� DEMOLITION ''�� WOODSTOVE/FRPL INSERT I i BUILDING RELOCATION <br />����i . OD coinnct rensou nuu rno0���'��--���— <br />CON7P4CT PRICE OF WORK � <br />OF.SCfl18EWORN�NDSOUAf1EPOOTACF.INVOLVEO /� � �� � <br />TTa � t � rr I �IIM• � .CuIMA !�- .. •�% l�rE� 1_ f�P / !N , .� 1' <br />�� � �.� —. <br />LEG0.L UECiOPIPTION OF PR07EHTY �SNOWN BEIOW OIl A1iACN P(N1R COPIES� <br />ior �JD - ��i aiocK �'_ or _�IC3'��ih �`� <br />����' ✓-1. �%�) <br />. �y P�OJECT�DURESS <br />i <br />� v�uMeiNc <br />, N0. TYPE OF FOfTURE OR <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY{M/ASH BASIN) <br />SHOWER <br />' KITCHEN SINK 8 DISP <br />� ' DISHWASHER <br />� LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />� �� DRINKING FOUNTAIN <br />' � FLOOR ORAIN <br />� i _ BACKFLOW PREVENTERS <br />! ROOF DRAINS--RAINLEADER <br />i SINK ISERVICE—BAR. ETC.1 <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FBONT SETBACN RERR SETBACK <br />I �� � <br />USEZONE LOTAREA <br />2 - o�o � <br />IYPE 0� �GON1y5 R�I IOWABIF 7 E MT TL7ONS1i RCIIIRI <br />.JlJV `�,v <br />SIZE Oi BLOG. NO.OF STORIES <br />7z� Aaxnan� ! <br />OCCUPANCY LOAD FIRE SPRN,KL'AEFS REOD <br />' /� <br />fiEA50N FOA SPRINKLERS <br />PY <br />I HEREBY CLRTIFY THAT I HAVE flEAD AND EXAMINED TH!S <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A:I_ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN C:Fi <br />NOT. THE GRANTING OF A PERMIT DOES NOT PR'cSUME TO C�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEHFORMANCE OF CONSTAUCTION. THAT I AM AUTHORIZED BV THE <br />CIWNEF7 OF TNIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />NO. TYPE OF EOUIPMENT <br />A�C—NHNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />I1NIT HEATERS—B. <br />GLOTHES DRYERS <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPIACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDFSETBACN / PL�NC��UMBEJ), F� <br />, <br />j _ «'i� .. <br />VAC�NT SITE FEES <br />N lU eui�oiNc <br />IKWMIK.v �IOMryNf111iM11H^S ---- <br />r.nn�m � � p�UMBING <br />� <br />BASEMENT MECHANICAL <br />AIu — .. <br />NEIGIIT UMR�710N ADDITIPNAI PLAN CHECK <br />SPFINNLER <br />SiATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBIIC WORKS <br />�D�A� C�) (� <br />TnY t:UUE IS 3105 "^� <br />FEE <br />� - <br />�__ <br />--T— <br />SUB TOTAL $ ; <br />PERMIT $ � <br />TOTAi, FEE $ <br />� necemrNo <br />S�J ' 00/ <br />VALUA7fON FEE <br />� <br />7�E'?7' _�_I� <br />i <br />i <br />� � r70 <br />i <br />� <br />i <br />� �5� <br />-�-- <br />T <br />r ;�v <br />� <br />