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r <br /> APPLICATIOPI FOR CONSTRUCTIJN PERMIT e� <br /> F TO BE COMPLETED IN INK—PLEASE PRINT <br /> Ina EVBrOnen <br /> y�y <br /> CITY HEATWGSYSTEM• GAS ❑ELECTRIC ❑ <br /> p x BUILDING DEPARTMENT <br /> 3 to 259.8810 ❑ <br /> �J <br /> H ElDEMOLITIO'� N COMBINATION BUILDING Ll MECHANICAL ❑PLUMBING <br /> v PHONE <br /> 0 6R _' _ MAIL ADDRESS CITY _ '/�� /aJA WaeU ��SD,I, S3�d�yy <br /> z / 2/n ��I�LE <br /> -C -- 21P —� `IE <br /> 'V H Al F ENANT MAIL ADDRESS Cm PNO <br /> N H <br /> A09RCHITECT OR DESIGNER AIL A00PE5S CITY 1­3ZIP PHONE -17aY <br /> o D11�- Q�Ch r),109 <br /> MAM1 ADDRESS IIP PHONE LICENSE{ <br /> cm .7i�ul���( <br /> n O GONTMCTOR <br /> H M'CHANICALtO TRACTOR MAIL ADDRESS <br /> Ciry ZIP PHONE Lk.xNI <br /> 3 CITY ZIP PHONE IICENSEI <br /> H y PIUMBNG CONTRACTOR MAIL ADDRESS — <br /> 0 fA <br /> � y a woRK <br /> PrNEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL INSEP.T Cl BUILDING RELOCATION <br /> L� CONTACT PERSON AND PHONE NO. <br /> H co <br /> Fj Q N CONTRACT PRICE OF WORN <br /> /DEESCA;SE K AND SQUARE FDIC INVOLVED <br /> lO/ ISED USEa 11 , 1. L <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S,ng c/� nz, / '�E'S`/( '/�^� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L AL DE RI Tlal6 P/ROP/+6RTY I IOWN BELOW T'ACN WRCF'?IE9) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �y�C f WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> BLOCK of �) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> /� / OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> `}' L APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> R287CONTRACTORS LAW 18.27 FICA!AND 288.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> f� X <br /> • c7l PRO.IECT ADDRESS APPLICANTS CITY BUSINESS LICENSE NO.ANO BUSINESS NAME <br /> PLUMBING MECHANICAL <br /> ( FEE NO. TYPE OF EQUIPMENT FEE <br /> N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) I A1C CEDAJH A LG UNITS-H.P. <br /> c / BATHTUB FORCED AIR SYSTEMS-B.T.U.--ME <br /> LAVATORY(WASH BASIN( I- UNIT HEATERS-B.T.U. M <br /> SI(OWER CLOTHES DRYERS <br /> KITCHEN SINK 6 DISP i- VENTILATION FAN <br /> DISHWASHER �' - I RANGE HOOD <br /> LAUNDRY TRAY ; / WATER HEATER <br /> WOOD STOVE ' <br /> IF WASHER / METAL FIREPLACE 6 CHIMNEY '— <br /> FIREPLACE INSERT ' <br /> G FOUNTAIN I HEAT PUMP ' <br /> RAIN GAS PIPING <br /> W PREVENTERS K <br /> EXHAUST FANAINS-RAINLEADERSRVICE-BAR,ETC.) <br /> I <br /> I I <br /> I <br /> �i <br /> SUB TOTAL S i� SUB TOTAL $ <br /> DE <br /> S ' PERMIT S ' <br /> TOTAL FEE S A S" TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: PLAN RECEIPT NO <br /> FRONT SETBI�GK REAR SETBACK VBMEMEW <br /> SOK/>i'M�BE�I FEE`l9FEEUESLOT AREA FEES _WAION 5LBUILDING77HllROIMT{TYPEa CGNn.ALLOWATAE TrrLa WM4L A�TWIPLUMSINOfv qq <br /> BMS OF BLDO� NO.OF STORIES MECHANICALF+ Ljlp2 <br /> OCCUPANCYADDITIONAL PUN CHECKLDAP FIRE SPRNKLERS REDID�� OTHER <br /> REASON FOR SPRNKLERS STATE BUILDING SUFCHARGE <br /> INTAKE BY PLANS APPPOVEDBY CITY OF EVERETT PUBLIC WORKS 2 ' <br /> LOCRLSALES <br /> I/3p 9 TAX CODE IS 3105 TOTAL <br />