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APPLIt:A�ION FOR COIdSTRUCT�ON PERMII�!" �✓�" <br />TO BE CuMPLETED IN BLACK INK—PLEASE PRliv i <br />BUILDING DEPARTMENT HEATiNG SYSTEM: �J GAS I� ELECTRIC IJ � <br />259-8310 <br />I I DEMOLITION I I COMBINATION Iu�BUILDING s�MECHANICAL I�YPLUMBING I I SIGN <br />oWN[P MMLnoov[5s clrv 21r rHOHE <br />I - Sc' u c� I S!� J I• u lC A/1,'L, �� 5r� a r,, LdA %.S',i''iJ � 3`/- a�l '! <br />Tf.N�NT M�IV�DORESS CIiY ZIP 1'HONE <br />ARLMREGTOfl�ESIGNER MAILAOORESS piY ZIP PHONE <br />Gl31ER�L CONiF�CTOfl IdNL RO�RE$$ CIiY LP PIIOt![ $TAiE LIC[IlSE 9 <br />f�i, 1-5�h��1� i5da�-a�`_an�'cc_l�o Sna c�,� r,%r��i'i _�3y-o2/7 (t'Al S oGSMI <br />MECNAlIC4LWNIRACIOR IdNLFDpIlE55 CIiY ZIP r'�IONC p Si fLp�ICErNE{� <br />�� •r�5 7s �Joh�� .pr. Cfun..C�.`-.-y�-,. WI) ��o��.� %S %�;'o % 11 F Fl�,ii od0�o��p <br />PLUMBINGGONiRACiOR MAILA��RESS CITY ZIP PNONE ST�TELICENSEa <br />1__.�.., �+:tL. ;�J .�.,;�. i rn.� �- sG�...9/G,. �H�W.--� 98a>,� �>'a-�i� � � £ v �„ :rv � �o N1 <br />CJtlTRFCT pRICE OF WORK <br />4ND 50`RE OOf iAGE IN40lVED I CONTACT PERSON FND PHONE NO. <br /><`1— ��f2�7�'L�i <br />PHOPOSeouyFeoFpW,fL01NG �t�/ <br />/Ju✓ c.o ✓ ��. <br />l[GAL DE�S/G�BIPTI OF PPOPER(Y <br />LOiJ—'�— BLOf.H — <br />• , ;'+ �Q, <br />1'nRCCI TA%I.D NUMOEP <br />�ow oa nrrncH �TGw%o cories� <br />OF I I � '{, �� . <br />C045TRUCTION LOAN LENDER. AODflESS, TELEPMONE NUTAdER <br />PROJECT <br />PLUMBING <br />/7�� �'�u�� U-J <br />NO. TYPE OF FIXTURE OR ITEM <br />�j, _ WATER CLOSET (TOILET) <br />BATHTUB <br />2 LAVATORYIWASH BASIN) <br />KITCHEN SINK E DISP <br />DISHWASNER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FI.00R DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.1 <br />FEE <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSEIBAQH .i3FnHSET�ACK <br />JSE ZONE <br />� 3¢ <br />iYPE OF WN57. <br />� <br />SIZE OF OLDG <br />I�YIS SF <br />OLCUPANCYI <br />� <br />REASON <br />iarnKF ov <br />N0 OF <br />FIF7E SPRINKLERS REO'D <br />0 <br />PLhN$ PPPPI VED �Y <br />Ja <br />DATE Z /.j /y � <br />SIDE <br />I HEREBY CERTIFV THAI� I HAVE READ AND EXAMIfJED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SP�CIFIED HEPEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICF <br />APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />I�.�,� �� �. <br />sicr�ei n� � o e <br />LIPlOUSiNI551iCINSf �b <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />!VC—A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—D.T.U. M E.A. <br />UNITHEATER.`—B.TU. M <br />� CLOTHES DRYERS <br />r� VENTILATION FAN <br />RANGEHOOD <br />f WATER HEATER <br />'JJOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />� EXHAUSTFAN <br />� <br />� <br />�— — <br />PLAflCMEC NUl69ER <br />� �OCI � <br />vncnNr sire <br />i.—i YES ❑ NO <br />OGLUPANLY HO �(OW[4�LLU�u > <br />LNOUC <br />�Z -3 I _ <br />unseraer+r <br />��: I YES f�0 <br />HEIGHt UfdIL�TIQIJ <br />� / <br />CITY OF EVERETT <br />LOCAL SALES <br />Tax cooe is sios <br />OUILDING <br />PWMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECN <br />OTHER <br />STAT[ OUIL�ING SURCHl+RGE <br />PUOLIC WOFiKS <br />TOTAL <br />SU8 TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />RE <br />��/7 <br />� <br />rtt <br />0 <br />i^ <br />�/ IS'�' <br />r ) <br />I <br />/ 1 <br />J. , I <br />/0 :o U <br />� i <br />i Ck"> <br />�� v � <br />T <br />".� <br />