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/�PPLICAT�O'"' FOR CONSTFiIJCT����I� PEFiMlT <br />TQ BE COMPLETED IN BLACK INK—PLEASE FRINT �' <br />9UILDING DEPARTMENT HEATING SYSTEM.: 'J GAS !J ELECTRIC J_ � <br />259-8810 <br />DEMOLITION ! COMSINATION i BUILl71NG ' MECHANICAL Cl PLUMBING I 1 SIGN <br />OWNER IdlILAD�RE55 CITY ZIP PMONE <br />� C��t- G�vrvt��/}s5 �v��7 9�r- �� c.v, �v��'�.�-Tt 4820� Zc�_3��3s <br />TFI;ANT fdAIL���RE55 CITY 21P PHONE <br />�qrryITECTOF DESIGNEF IAqIL FD�RE55 <br />CITV ZIP PHONE <br />�GE�pI/�LRAI.�L��S'I JMAILA[iDR�i%��� �%%{-//✓Lr LL�r �yL��(i� !7'J!�9 �ATELICT�< <br />/ax5 3 3Q�S <br />LIECNANICAlGON7RAC70R MAILADDRE55 GITY 21P FHONE STATELICENSEk � <br />PLUIdBINGCONTRACTOR 1dpIL�00flESS <br />CONTRACT PRICE OF N! N <br />lQ'3��•l a%���0 <br />�ES IBEWORKAtl� OU�F FOOTPGEINVOWED <br />� ,�,i�_� c.S�rrFr�` 9D X �� <br />PPOPOSED US'c OF BU.�ING <br />7� 7G�� C/Y►� 4- /LIorD� - .•r�� <br />L�G�L�ESGRIPiIONOFPROPER7Y�SHOWNBELOWOR TTC[�/ N%WOC�� <br />% �� � <br />LOT �7 BLOCH OF Ll /(l <br />%� �> / <br />PARCELTAXI.D.NUMBER <br />��2- -Gbc Y�� - <br />CGNSTRUCTIONLOANLENDER.r ORFSS.TELEPHCNE <br />�U o2 / �%� /`�"(�liS �� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHON'FR <br />KITCHEPJ SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFlINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />'FQR OFFICE USE ONLY: <br />FRGNiSETAFCK REAR $ETBACH <br />�/� <br />iYPEO�F.C.O�N,Si <br />�� <br />SIZE OF BLDG. <br />IR�fo Sf• <br />OCCUPANCY LOAf` <br />N/n <br />RE�SON <br />INTAKE 11Y <br />CITY 2iP <br />GONTACT PERSON FND PHONL N0. <br />LICENSE u <br />I HEREBY CERTIFY THAT I HA�lE READ AND EXAMINED THIS <br />APPLICATION AND KNOU! Tnt SAME TU tiE TRUE ADJD CORRECT. ALL <br />PROVISIONS OF L�':vS AND ORDINANCES GUVERNING THIS TYPF OF <br />WORK VJILL BE COMPLETED WITH WHETHER SPECIFIED H[REIN OR <br />NOT. THE 6RAPITING OF A PEFMIT DOES NOT PRESUME TO GIVE <br />.4UTHORITY TO VIOLATE OR CA�CEL THE PROVISIONS OF ANY <br />��THER STATE OR LOCAL LAW REGULATING :,ONSTRUCTION OR THE <br />PERFOR6IANCE OF CONSTRUCTIJN. THAT I AN AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA �TORS LAW 1 27 RCW AND 296.200 WAC. <br />.1 �l/1GJ�k? 8 `�' <br />cr�amae o ��E <br />GILYpU51NE55LIClIGf t10 <br />I NO. TYPE OF E�UIPMENT FEE <br />�� A/C—AiHNDLG UNiTS—I-�.P. <br />FORCED AIR SYSTe"MS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />— � <br />CLOTHES �RYERS � <br />VENTILATION FAN <br />� RANGE HOOfI <br />; WATER HEATER ' <br />r WOGD STOVE <br />� IdETAL FIREPLACE (WOGG BURNING) <br />; FIREPLA�7E INSERT � I <br />� HEATPUMP � <br />GAS PIPItJG <br />� EXHAUSTFAN � <br />SUB TOTAL $ <br />PERMIT S � <br />TOTAL FEE $ ' <br />SIOE SET�ACK <br />LOTAREF <br />NO. OF STORIES <br />� <br />FIpE SPRINKlERS REO'D <br />FlRE ALARM REOD <br />_ No <br />PLANSAPPROVEDBY <br />DATE �� �C]L+' <br />�� I SUBTOTAL $ i <br />� PERPn1T S <br />TOTAL FEE 5 �; <br />r �a a �- <br />PLANCHEC NU�ABF:❑ �EE RECEIPiNO <br />�l?���,� �,��9a 99s��s <br />VACFNT SITF 1'GCJ — <br />!—. YES �� NO BU�LD�NG �(._� - /�, (p�J ��K (�% Z Li J .i <br />�ccurascr r;oc�n,:[w.cu��ns � <br />caau= PLUM�ING i <br />�� � <br />i <br />BFSEMENT � MECHANICAL � <br />G YES VNO <br />HeiGHi uMi7anoN ADDITIONAL PLAN CHECK i <br />Z I � OTHER , <br />CITY OF EVERETT <br />LOCALSAL:S <br />TAX CODE IS 3105 <br />STATE BUILDING Sl1RCHARGE <br />PUBLIC WOIIKS <br />TOTAL <br />� S:J <br />__ . . . .. . �� . . �„ M• . � . . � .. �.�. <br />