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APPLICATIC"'� FOR CONSTRUCT'—')N PERMIT � <br />TO BE COMPLETED IN DLACK INK—PLEASE PRIN? <br />HEATING SYSTEM: J GAS � LECTRIC !J ] <br />BUILDING DEPARTMENT � <br />259-8810 <br />I DEMOLITION I 1 COMBINATION X BUILDING I' MECHANICAL J PLUMBING f=' SIGN <br />OWNEF � �dAILAD�PESS � CITY ZIP PHONE <br />J��us , �a.DRi6�k"a ?50$ '7*'DR•W' E�II Ggao3 (2�G) �Y7-5'f�2 <br />TENAGT �dAILADDRE55 CITY ZIP PHONE <br />Sf1M6 <br />pRCNITECT OR �ESIGNER fd�IL A�OPESS qTV ZIP PNONE <br />�� � <br />GENER�LGONTRACTOP IdAILA�OFESS GTV 21P PHONE STATELICENSE> <br />r �(-�N�� <br />ldECHANICFLGONIRACTOR 'dNLAODRESS CITY 21P PHONE STATELILENSEp <br />PLUMBINGCUNiRAC'OR M/dLA0�RE55 CITY 21P PMOHE STAiELICENSEtl <br />C A HICE OF WOBK <br />,�,d D c� <br />OE�Gf11PF bY0f1Y. Atl[� $CI�0.RE f OOTAfiG ItNCLVED <br />.-. _ . . n ...��. i . . u <br />� ,. n'� �.Js►u.s .. <br />LEGAL DESERIPTION CF PfiOPFRTy �SHOKN BELOW OR ATT�GH TWO <br />V /FLI�c ��1 <br />LOT�— BLOCK � UF <br />PARCEL TAX Lf�_NUTAa:R �� / <br />%V ��V <br />CONSTRUCT�ONLOANLENDER.�D�FESS, <br />��� <br />NUMBEF <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET �TQILET) <br />BATHTUB <br />LAVATOFY (WASH BAS;fJ) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAI��S—RAINIEADERS <br />SINK ISERVICE—BAR, ETQ) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: iZp�/ <br />FRONTSETBAGH REAF SETBAGK / <br />USEZONE� / LOT4fiEA � <br />iYPE OF LONSi. <br />� � <br />SIZE OF BLDG. <br />RE�SON <br />IHTAKG AV <br />NO. OF STORIES <br />2 <br />FIRE SPRINKL6F7 F[O'C <br />_L�° — <br />FIFiE ALARId RE�D <br />PlANS AP �ED BV <br />onre i� h /87 <br />FEE <br />R <br />e <br />ION[ NO. <br />�2Ti.� A OD <br />�6) 3 �F''I- <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORAECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFURM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 FCW AND 296200 WAC. <br />MECHANICAL ,_ <br />10. TYPE OF EOUIPMENT <br />A�C—A�HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VeNTILATION FAIJ <br />RANGEHOOD <br />WATER HEATFR <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />� U/{ G <br />SI�ESEiBACK � PLANCNE N UIdBER � <br />VACANTSITE / F� S� � <br />YES . ! NO BUi�DWG . <br />occwx:v aoo�owen�.cw;ns <br />� :3 PLUMBING <br />BnSernEN7 MEGHANICAL <br />YES ✓NO <br />nEiGHT urdi7p7loN ADDITIONAL PLAN CHECK <br />Z � <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />FEE <br />0 <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S _� <br />� <br />i <br />r— <br />;SD <br />• <br />