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API�LICATIC�`1 FO�i CONSTRUCT'-1N �'ERIV��T �w�� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT '( � <br />BUILDING DEPARTMENT HEATING SYSTEM: :J GAS p ELECTRIC 'J <br />259-8810 <br />f-'' DEMOLITION ! i COMBINATION <br />OWNER IApILADDRESS <br />�'I��. /Joh FFS�� �y�i-i,�� <br />fENANT lAqILA�DRESS <br />ARCHITECTOROEEIGNER MNLADDRESS <br />GEN ALCONTRpCTO lAqILAD�RESS �,G� <br />ff �: UJ • �J���U l��X � i <br />MECHA ICALCONT:iACTOq WqILAO�RFSS // <br />� ii_ .� <br />PLUMBINuGONTRqCTOR MNLAOORESS <br />COhTH,OC f PRIGE OF WORK <br />_,� � �y� <br />DESCflIBE WOR1(AND SOUAFE FOOTAGE INVOLVED <br />X BUILDING MECHANICAL i_ I PLUMBING !' SIGN <br />CITY ZIP FHONE {�-1 _ Z �l �� <br />Ta!-O f—F � j /�y' / it..nyo S:'/ • O!�✓ <br />PROPOSED USE OF BUIL�ING <br />LEGAL OESGRIPTION OF PPOPERTY �SHO WN BELOW OR ATTPCH TWO COPIES� <br />LOT — B�OCN OF _ <br />TP%I.D.NVMBEfl <br />���,�, $-ODU <br />JCTION LOA`I LENDER. <br />PROJECTADDRESS <br />5'�� (�, - /� �� �ue � <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEfl <br />KITCHEN SINK 8 DISP <br />DISHWA3HER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. FTC l <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN RF.AR SETBACK <br />USEZONE LOTFREA <br />iYPFOFC(1H57 NOAFSTORIES <br />SIZEOFBL�G. FIFESPRINKLERSREO'D <br />OCCUPANCYLOAD fIREAI�PMRE00 <br />REASON <br />INTAKE BV P�qNS APPRO:�EO BY <br />DATE <br />SIOE SETBFCK <br />CITY <br />CITY <br />� <br />CITY <br />CITY <br />ZIP <br />ZIP <br />ZIP <br />zm <br />CONTACT PERSON AND PHONE NO. <br />rnurvt <br />PMONE <br />PNONE�y�ay�, STAlELICENSEa <br />S i <br />PHONE ST E LICENS� <br />PHONE STATE LICENSE a <br />i I-'ER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVE7NING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIrIED HEREIN OR <br />NOT. THE GRAIJTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TI1E <br />PERfORA1ANCE OF CONSTRUCTION. THAT I AM 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 />CONTRACTORS LAW 18.27 RCW A�D 296.200 WAC. <br />x_�-�,���, y ��/� <br />SG�i4ipq[ �ntE <br />Ciiv BUS�NE55 LiC[NS[ NO "" <br />FEE N0. TYPE OF EDUIPMENT FC•E <br />� A�C—A/HNDIG 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 J <br />� RANGEHOOD , <br />WATER HFP.TER � <br />� WOOD STOVE <br />; METAL FIREPLACE (WOOD BURNING) � <br />� FIREPLqCE INSERT � <br />� <br />' HEAT PUMP —� <br />� GAS PIPIWG � <br />� EXHAUST FAN ; <br />NUM1IBER I PEE <br />- YES �� NO <br />BUILDING <br />CCDJCAdtv rypOIONiLLV�Lp1G5 -- <br />LIIO�P <br />PLUMBING <br />B�SEMENi MECHANICAL <br />r: YES �=, NO <br />NBGNT ur,ti7nTioN ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />� <br />SUB TOTAL 5 <br />PERMIT S � <br />TOTAL FEE S � <br />� �.) <br />� <br />I <br />�— <br />i <br />� <br />^___ <br />i <br />T— <br />�� 27 <br />i <br />� <br />;— <br />; ';�� <br />