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APPLICATION FOR CONSTRUCTIvN PERMIT <br />,. e <br />r <br />' TO 8E ^.OMPLETED IN INK —PLEASE PRINT <br />everett HEATING SYSTEM J GAS ;o f I i C T f;v J <br />BUILDING DEPARTMENT <br />259-881D <br />BUILDING DEMOLITION X COMBINATION MECHANICAL PLUM9ING SIGN <br />Omrn MAIL ADDRESS ._ u� .._..._.__- ulA at�3'7 <br />•-- <br />CITY ZIP PHONE <br />ARCHITECT OR DLSIGNER MAR AODPf 55 <br />PHONE LIGENSEI <br />GENERAL CONTRACTOR MAILADDPESS CIIV bP <br />- - -- ALi-WFp=-tt29—A/ <br />C17Y ZIP <br />CITY ZIP PHONE UCENSEN <br />PLUMBWGCONTRACTOR MAK ADDRE55 <br />� ,� c, NONDMFSN LJti <br />CLASS OF WORK wMmcTnvWFRPI INSERT BUILDING RELOCATION <br />X NEW ADDITION ALTERATION ncrRln ��••••-•• <br />----- <br />CONTACT PERSON AND PHONE NO <br />UO SO 0-u <br />C L ZOO <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Nest) /350 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUaDING <br />APPLICATION AND KNOW THE SAME BE TRUE ANDND CORRECT. ALL <br />�/A16L FAM /Er 65 OArA1G <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROP°gTYI KIVM BELOW OR ATTAGNiWRCOPIESI <br />WORK LCOMPLETED WITH WHETHER SPECIFIED <br />NOT. THE GRANTING OF APERMIT DOES NOT PRESUME TO GIVE <br />LOT_ BLOCK of <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br />i <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />OF SPORT F LA•T 120 _s <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />., r i ., -r..c R A_ND <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SIGNATURE OF CONTRACTOR OR AUTNGRIZED AGENT GATE <br />3 9T �� <br />/Qu�1E JEST ag��.�,,cATr rn1c. <br />3/�/ <br />APPLK:ANTS CITY BUSINESS LICENSE NO AND BUSINESS NAME <br />PROJECT A� E <br />' <br />' el' 5f , <br />MECHANICAL <br />PLUMBING <br />TYPE OF FI%TURF OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />A/C—AIHNDLG UNITS—H.P. <br />2 WATER CLOSET (TOILET) <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />2 BATHTUB <br />UNIT HEATERSE B.T.U. M <br />2 LAVATORY (WASH BASIN) <br />THESOAN <br />_ SHOWER <br />FAN <br />VENTILATIONNAN <br />VENTILATION <br />/ KITCHEN SINK t DISP <br />1 <br />RANGE HOOD <br />DISHWASHER <br />% D <br />; <br />WATER HEATER <br />LAUNDRY TRAY <br />WOOD STOVE ' <br />CLOTHES WASHER <br />' <br />METAL FIREPLACE a CHIMNEY .Q,i.CI1— <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />HEAT PUMP ' <br />^ FLOOR DRAIN <br />OAS PIPING ' <br />_ — BACKFLOW PREVENTERS <br />EXHAUSTFAN ' <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE —BAR, ETC.) <br />I ' <br />T <br />SUBTOTAL t <br />SUBTOTAL t <br />PERMIT t <br />TOTAL FEE t <br />' <br />PERMIT t <br />TOTAL FEE t <br />'r <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK I REARI <br />13M N 04 <br />FRS REOD <br />vL v <br />wn <br />INTAKE BY PLANS APPROVED BY CITY OF EVERETT <br />A g LOCAL SALES <br />RECEIPT NO <br />tom' <br />BUILDING <br />WVI '7U <br />PLUMBING <br />' <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />OTHER <br />I <br />'T— <br />STATE BUILDIFKA SURCHARGE <br />PUBLIC WORKS <br />I <br />