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� , <br />'��° APPLICATIO►-N FOR CONSTiRUCTl0�1 PERMIT � <br />TO BE CUMPLETED IN BLACK INK—PLEASE PRIh � <br />HEATING SYJTEM: L�iGAS U GLECTRIC U I <br />BUILDING DEPARTMENT <br />259-8810 <br />I I DEMOLITION I1 COMBINATION I�.t�BUILDING It�!'MECHANICAL L�LUMDING I I SIGN <br />OWIJER <br />n_ , <br />ARCMITECT ON DESIGNEF <br />GENERALCONTflACiOR <br />'fi�i, �-s�h�� <br />IAELHA ICALCCNTflICTOR <br />'LUMBING WNTRACTOR <br />7 �-+ �i�✓ <br />,..1,•, :..�,.., . . <br />GCNTRFCT PRICE OF WORI( <br />DESCRIFlE WORK nND SJUnI <br />PP( °C <br />LEGAL <br />LOi— <br />MAiI ADDRESS <br />IS�P I•U � l,� <br />MAIL ADDRESS <br />IAFIL AD[1RES5 <br />MnIL AODRE55 <br />l5b I•a /I�i���� <br />MAIL �OORESS <br />s na�t �r. <br />1.1AIL AODRESS <br />,, ,�.�� �� <br />� <br />iTpGE INVOLVED <br />UILUING J � <br />A M <br />« ./.. -ii - <br />OP PliOPEFTY �SHI <br />- BLOCK — <br />PARCELTF%IO.NIIMBEF <br />CONSTRUCTIONIOANLENOER,A0DRE5S. <br />CITY <br />� <br />ZIP rn�n� <br />�.fJ�1�:% .J J �- v <br />Z�p PMONE <br />CITY ZIP PHONE <br />CITY 21P PMONE ST�TE LICENS[ � <br />Sna . t,,�j ii,�-�:i _.3.3�/-a8/7 RA l u NS oGS /YI I <br />��7y 21P PMONE Si El6EN5E4 <br />` � �' ' � 2k' �R;�� ;�a�C� <br />�,�,-�-,, �.�� �aa3� 7s-� � -� � _ <br />�/CIiV ZIP PMONE u..'iELICENSEu <br />.. ,1�.�..,..� 98a9a �>'a-�i� i S�u��-, �p 13�a�_ <br />CONTACTPERSONI.NDPHONENO. <br />i?r��S�h��V� 33t�gi7 <br />�����`�-�-'_"_ G� i HEREBY CERTIFY THAT I HAVE REF,G �AN� EXAMINED THIS <br />-- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />C.�.o a PROVISIONS OF LAVlS AND ORDINANCES GOVERNING THIS TYPE OF <br />LOWORFTTFCMTWOCOPIES WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�� a sd,( � NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE <br />oF AUTHORITY TO VIOLATE OR CANCEL ThIE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNF <br />PERFORMANCE OF CONSTRl1CTION. THAT I AM AU7HORIZED BY Thu <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICi� <br />APPUCATION IS MADE AND I COMPLY WITH -HE STATL <br />CONTRACTORS LAW 18.27q RCW AND7296200 WAC. <br />PMONE NIIMBER �V / .<� t'�/I /�/ / // /, <br />Jl1Sl� 4 / SL 9- 3�- �i <br />iL � '�tit'f�� <br />, sicrvnrunE wrc <br />PLUMBING <br />p, TYPE OF FIXTURE OR ITEM <br />S WATER CLOSET �TOILET) <br />BATHTUB <br />LAVAT09Y(WASH BASIN) <br />SHOWER <br />( KITCHEN SINK 8 DI ;P _ <br />� DISHWASHER <br />LAUNDRYTRAY <br />( CLOTHES WASHER <br />URINAL <br />DflINKING FOUNTAIN <br />FLOOR DRAIN <br />6ACKFLOW PflEVENTERS <br />ROCF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PEFMIT 5 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />fFiONTSETBpCK � PLARSEiOAL� <br />Zo 20 <br />USE Z NE ,'j� LOT AdflEA`Jq <br />. T ti-f�.. 11 <br />IYPE Oi CON9. NO OF STORIE: <br />1/_� � �_ <br />FIRE SPRINKLERS FEOD <br />N'� <br />flflE FIAPfA REOD <br />�� <br />REASON <br />INTFNE BV PLANS �PP,F�D AY <br />J <br />onre ,� /, , /c <br />fEE <br />N0. TYPE UF E�UIPMENT <br />NC—NHNDLG UNITS—H.P. <br />� FOFCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />I WATER H[ATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FA'� <br />FEE <br />0 <br />SUB TOTAL b <br />PERMIT $ � <br />TOTALFEE $ ! <br />SI�ESETBACN PL�NCHECKNUTAOER FEE � <br />S � �� �.�_ v t <br />VAC�NT SITE FEES �A <br />�YES ❑ NO BUILDING L•r� <br />i <br />ocruPnna �.uarownu+uuwns — <br />��''� I PLUMBING _ <br />BnSEM[NT p�7ECHANICAL <br />n ves �c <br />HEIGHT LIMltaii0t� — � ADDITIONAL PLAN CHECK <br />/ lG� � <br />�l� OTHER <br />STATE BUILDING SUFCWIRGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />RECEIPTNO r <br />J �� <br />ION FEE <br />o .� ':�C <br />