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- <br />, . APPLICATIO�� FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE�INT ���� <br />HEATING SYSTEM: I� GAS ❑ ELECTRIC O � <br />BUILDING DEPARTMENT <br />259-8610 <br />[� DEMOLITION ❑ COMBINATION <br />OWNER MAILADORESS • j7 <br />�etiler��,���n pn„r�,e s�,��o 3 <br />TENANT M�IIADDFES . , VII� <br />�%JD�i�iDVl C�llc%KBh tJo�<fhJGS'� L <br />ABCHITECTORDESIGNER MAIIADDRESS�..��.1 ,��; <br />AECHANICAILONTFACTOR <br />I\ <br />'LUMBING CONTRACTOR <br />�1 <br />.ONTpq�T PRILE OF WOFK <br />USE <br />MAIL ADDRESS <br />o :r 11 <br />lAAIL A�DRESS <br />MAIL A�DRESS <br />iA <br />LEGAL OESCRIPTION OF PROPERTY (SNO WN BELOW pp ATTACH TW 0 COPIES� <br />LOT BLOCK OF <br />�—I��G��� � �G� ���- <br />PARCELTA%LU.NUMdER <br />�'i h� 001 0 0 3 0�03 <br />:ONSTRUCTIONLOANLENDEfl,ADDRE55,TELEPNONENUl.1�ER <br />PLUMBING " � <br />N0. TYPE OF FIXTURE OR I <br />� WATER CLOSET (TOILET) <br />� BATHTUB <br />LAVATORY (WASH BASIN) <br />— SHOWER <br />� KITCHEN SINK & DISP q- CD� <br />— DISHWASHER <br />— LAUNORYTRA <br />— CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE S <br />FOR O�FICE USE ONLY: <br />FRONT SETBACN REAF SETBACK � <br />C�' �� <br />US[ZOy I �OTAREA <br />� <br />ttPE�OiCOtA1T <br />�-1�1 V <br />SIZE OF BLDG. <br />REASON <br />� <br />INTpNE 9Y <br />� <br />FIFE SPRINNLERS FEO'� <br />No <br />FtRE ALARM PEO'D <br />p�ANS APPROVEC BV <br />o�.�M /�¢,/, <br />BUILDING <br />I BdrfY <br />� bL # D: <br />i�n Y <br />_ , � d.�nt . <br />CITY <br />� <br />CITV <br />CITV <br />FEE <br />0 <br />'�MECHANICAL �PLUMBING ❑ SIGN <br />LIY PHONE <br />i �iv�.re�l" U1,�1- qk'w I (�) �i�i�G �i <br />ZIP PMONE //���� �j�� � <br />�F�, <br />�ehu� ��;S�c.I�D,$ell�vue, �1i_A-qKo <br />21P PMONE <br />N�, S�e ioo, �,c I Ie�Ue wa P��� �u�) � <br />21P VFION $TATE LICENSE v <br />ZIP PHONE STATE LICENSE 4 <br />ZIP PHONE STATE UCENSE n <br />CONTACT PEFSON �NO PMONL NO � <br />%/%JT/o � /n�(n . '1,2! � <br />i HEREBY CEFlTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPIETED WITH VJHETHER SPECIFIEC HEREIN OR <br />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 CONSTAUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRFCTORS LAW 18.27 RCW AND 296.'eJ0 WAC. <br />scr+nrune o�ie'v'�^ � <br />LRY pUSINE55 4CENSE NO. <br />MECHANICAL <br />NO. TYPE OP E�UIPMENT FEE <br />� A/C—A/HNDLG UNITS—H.P. <br />�� FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />— UNIT HEATERS—B.T.U.- M ; <br />— �LOTHES DRYERS �— <br />— VENTILATION FAN ' <br />RANG HOOD <br />WATER TER <br />-' WOOD STO � <br />— METAL FIREPLA (WOOD BUANING) � <br />" FIREPLACE INSER ' <br />_ HFAT PI IAAP � <br />GAS PIPING <br />EXHAUSTFAN <br />SI�E SETBACK PLAN CNECK NU�•�BE�� <br />7 <br />VACANT SITE PEES <br />❑ YES �NO BUILDING(��'% "� r <br />otcuvaucr r�o ormvRuricuxits � � �� � �" <br />acuv PLUMBING <br />onSEr.IENT MECHANICAL <br />❑ YES �.'�(NO — <br />HEIGHT unnTnilOr+ ADDITIONA� PLAN CHECK <br />?� OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBIIC WORKS <br />LOCAL SALES <br />TAX CO�E IS 3105 TOTAL <br />SUBTOTAL 5I ; <br />PERMIT S � <br />TOTAL FEE 5 � <br />U�����/ <br />r�, <br />j� � d <br />� <br />