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AP�LI�A`�'1� 1 FPJR �OPISTF�iJCT' �iV P�RM � �- <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��'T <br />HEATING SYSTEM: 'J GAS � ELECTFIC J_L✓_�—_� <br />BUILDING DEPARTMENT <br />259-881G <br />DEMOLITION I COMBINATION �C BUILDING MECHANICAL I I PLUMBING SIGN <br />OIYNER 1.1AILAODRE55 CITY ZIP PHONE <br />��iza_r� ►'rt�l �.:.�1 9`li`I �i �.tv� se` c✓a-nzr, R9.�os� c�g�-s33� <br />T[NAlT M41�ADDRESS CITV ZIP °MONE <br />ARGNITECT OR �ESIGNER IA�IL �DDRESS CITY ZIP PHONE <br />1.!AIL AD�RE55 <br />MECHFNIGALWNTR�CTOR �dA�LA0DFE55 <br />PLUhIBINGCONTRFCTOF MAILAD�RE55 <br />CONTRACi PRICE OF WOPK <br />�� <br />�ESCRIBE LVORH AND SOUARE FOOT�GE INVOLVEI <br />�,'�'d -�r � n <br />GITV ZIP <br />— GITY ZIP <br />CRV ZIP <br />PHONE STATE IICENSE k <br />PNO4E STATEIICCNSEa <br />PHONE STATE UGENSE a <br />CONTACT PERSON AND PMONE N0. <br />I HEREBY CERTIFY THAT I HAVE FEHD AND EXAM�NED THIS <br />Pnoaoseo use oF aw�owc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�A/�K/A!! !� Sr Y�`C STR� PROVISICNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�e�n�oescaianoNOFanoNEarv�snownee�owoan.rncHTv+ocories� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br />._%z% LRSr fiDc� {N7nI NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�o. e�ocn oF AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br />i i OTHER STATE OR LOCAL LAW REGULATING CON5�RUCTION OR THE <br />_��l ��✓ T2 N-�ll�r.� /U�.N�qE /� l��Lrr P"� pERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />SNnNUis�l N C��ciN'%� �'1��5/f/Al1rTD.tI OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAJ�ION IS �MADE AND I COMPLY WITH THE STATE <br />, �,�c[� Tnz i o Nun+aea CONTRAC/fORS LAyV 1827 RCW AND 296200 WAC. <br />y�:.��c�o _ 03`�' <br />CONSTRUG110NLOANLENDEF.A�DRESS,' <br />PROJECT <br />NO. TYPE OF FI;<TURE OR Il <br />WATER CLOSET (TOILGT) <br />BATHTUB <br />LAVATORY (W�SH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES'NASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAItJS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />NU1dBER <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSET�ACK R[�RSETBACK <br />/ �/ <br />USEZ "' LOTrtAREA7�^ <br />�' � / L /V � <br />iYPE 04 COtl57. NO.OF S70RIE5 <br />f <br />SIIE OF BLDG. IJRE SPRINKLERS REOD <br />�68 SF <br />OCCUPRNCY LOAU FIRE ALARId REO'D <br />�a N � <br />�E�SON <br />wrnKe ov � PL�NS <br />DATE /.�/ I <br />PEE <br />0 <br />cirruusm��/ ��uus�rio <br />MECHANICAL <br />10. TYPE OF E�UIPMENT <br />A/C—tiHNCLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SIDE SETBACK � PU�N CHEf,K NU1.1�)ER <br />� I / , <br />vncnNr sire FEES <br />:_��. YES L NO BWLDING <br />OCCu�:Y.Lv 110 Oi �P:FLLiAG'J'I�15 <br />aeur PLUIdBWG <br />�' � <br />2ASEMENT � MECHANICAL <br />i7 YES . �NO <br />HEIGHr urdlinTlON ADDITIONAL PLAN CHECK <br />Z� OTH[R <br />STlQE BUILDING SURCHAFlGE <br />CITY OF EVERETT PLIOLIC WOFKS <br />LOCAL SALES <br />TAX CODE IS 3105 rora� <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FE[ S <br />0 <br />NO <br />