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----T- <br />A�RL4CAT10N FOR CON�TF;UCT�4�rl �'ERMIT �;,%�, <br />TO BE CuMPLETED IN BLACK INK—PLEASE PRllv i �E� <br />rHEATWG SYSTEM: U GAS IJ ELECTRIC ❑_ <br />BUILDING DEPARTMENT <br />259-8610 <br />f 1 D�MOLITION f 1 COMBINATION I✓BUILDING irfl'AECHANICAL G�LUMBING f l SIGN <br />OWNER lIAILAODRESS CITY 21P PNONE <br />/^. <br />! -$c Uo� lS� � I- CJ A,�Lc �cl Sn � F� C�Jfi %.S,r'/-� 3 S`� a K/ % <br />TEV�NT MAILFDORE55 CITY ZIP P��ONE <br />ARCHITECTORDESIGNER MAILADORESS CITY 21P PMONE <br />GENERAL CONTRACTOR MFIL AODRESS CITY 21P PMONE STATE UCENS[ u �� <br />iA I� I-S�h��k iSd !-o K n,�,�cc l�d S�oh. ��' --',�-= '� .��`l•u8/7 Rr I� IS oG r <br />MECH�tICRLLONiRACTOR MAILFDORE55 CIiY 11P ViIONG Si tELIC[N`Ee <br />.. , . � . � �� � � � � pk F ;F�' ;�a�c� <br />,r • r r, �,-, . , <br />'LIIMBING CONTflNCTOR <br />?.>..�,,, :.�.., ��. <br />CONTRFCT PPICE OF WOFK <br />JESCRIDE WOR�: ANO SOUP' <br />lAAIL A��RESS <br />',:.. aa 8 - 5��... <br />/ <br />ITAGE INVOLVED <br />PR070SE0 E OF 011ll �iNG „/ � <br />� ✓ "I�' <br />LEGFL OESC(IPTI 1 OF PROPEBTV �SH( <br />�p7___�.�— BLOCK — <br />Ci , �(,� . (.�c.a.(.tvi <br />PAflCEL TAX I.D. NUMBEf± <br />CON$?pUGTION LOAN LENDER. AD�RE55, <br />PflOJECT ADDRES.`�i ///v n <br />.3" <br />PL'JMBING <br />N0. TYPE OF FIX.TU <br />Y <br />� WATER CLOSET (TOILI <br />> BATHTUB <br />� LAVATORY(WASH BA: <br />SHOWER <br />i KITCHEN SINK 3 DISP <br />( DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOVJPREVEN' <br />ROOF ORAINS—RAI� <br />SINK (SERVICE--BAF <br />FOA OFFICE USE ONLY: <br />FRONTSETpPCK R@AHSET <br />�'� a/E <br />USEZGNE LOTAREA <br />�=3 P�J /„� <br />iYPE OF C01lSi. N0. OF ST <br />II4�iJ rf�t <br />4i S SF C:�A <br />OCCUPANCVLOA� <br />REASON <br />INTAKE OY <br />G <br />r�., w� >8a� � `7 s"� o � . — <br />CITY ZIP �'��ONE �TATEUCENSEA <br />�r._�....._..� 9�a9� 6>'a•�i�� � �urr, �p ����'1 <br />CONTACT PER'oON AND PHONE N0. <br />-U <br />I HEREBY CERTIFY THAT I HAVE READ AND EY.AMINED THIS <br />qPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />L.L.n o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�owoan"Ti;CHT_�yocoaiEs� . WORK WILL BE CONPLETED WITH WHETHER SPECIFIED HEREIN OR <br />� � NOT. THE GRANTING OF A PERMIT DOE6 NOT PRESUME TO GIVE <br />°F d AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. TFIAT I AM AUTHORIZED BY THE <br />OWMER OF THIS PROPERTY TO PERFURM TNE WORK FOR WHICF <br />APPLICATION IS MADE AP�D I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCN1 AND 296.200 WAC. <br />�% ��(�I,U�t � j/J <br />ORITEM FEE <br />PEFAIIT <br />70TAL FEE <br />fIRE SPRINKIERS REO'D <br />FIRE hLARM <br />P�ANS APPR W EO BY <br />J ►� <br />DATE Z/l/�9S <br />0 <br />0 <br />0 <br />���s�:���<<�:;<<�o <br />ANICAL <br />TY'E OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT H[ATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WO�D BURNIN( <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />PLAN CNECK NUTAf1EN <br />y'(�'��/ <br />vncnr+r s�re rtt5 <br />f i YES ❑ NO eui�DwG <br />o�-cu�<nn xoorow¢wucwu�s <br />�cao� i PLUMBING <br />FinS[MENT MECHANICAL <br />i ; YES `✓O <br />HE�GMr u�nrtAnOrv l ADDITIONAL PLAN CHECK <br />� OTHER <br />STATE 9UILDING SURCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />0 <br />SUB TOTAL 5 <br />PERMIT $ � <br />TOTAL FEE $ ! <br />Fee rt�r�., �..,. <br />�''O //i / G <br />vei unnnN � FEE <br />