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APPLICATIO:�` FOR CONSTRUCTI,iN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-;B10 <br /> DEMOLITION COMBINA710N BUILDING MECHANICAL '/.PLUMBING ' SIGN <br /> ONNER M�IL IIDDRE55 CITV ZIP PMONE <br /> �Je�''pit I�nef ���n�t- 1� � 'n s //�o �cif�'� �'erPtf- 9SJ�oi <br /> TEN�N7 MAILADDRESS GITV 21P MONE <br /> ARGHITECT IXi DESIGNEfl MAIL HD�RESS dTY 21P PNONE <br /> GENERIL CONTRACTOR M�IL RODRESS GITV 21P �P����,— ST�TE ULENSE• <br /> L.��S � Co„5t T�� y�ai ��� 5 r,� /�'lu�'l-l�"`� -� <br /> ii i � �.�j h✓.� CA�'cLcr/GcNif <br /> MECHANIGALGONTRIICTOR MRILADDRE55 � QTY ZIP PHONE SUTELICENSE� <br /> f'LU/MBMG COHTRACTOp MAIL�ODRESS CITY 21P PMONE STATE LICENS[t <br /> ��4Je�f �or ��S �� �� a 900��/7�� -�`T 5 E } J�no1.a.+..i5� 9A290 [✓R7�i261P/l.yT`f <br /> a�ss a wonK <br /> �. NEW �� ' ADDITION X ALTERATION . REPAIR DEMOLITION �. WOODSTOVUFRPL INSERT BUILDING RELOCATION <br /> CANTACT PERSON AND PHONE N0. <br /> CONTRALi PRICE OF WORK <br /> DE5CR�BE WORIc�ND SOUARE FOOLRGE INVOLVED <br /> r T. L <br /> PNOPOSEDUSEOP9UI m� i HEREBY CERTIPY THAT I HAVE READ AND EXAMINED THIS <br /> �� �«� ��l �� APPLICATION AND KNOW THE SAME TO BE TRUE AND GORRECT.ALL <br /> LEWL DESCRIPTION OF P TV(SNONM 860W OF ATT�GH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED NSREIN OR <br /> �pr e�ocK oF NOT. THE GRANTING OF A PEFMIT DOES NOT PRES'IME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROV'SIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' PERFORMANCE Of CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNE(i OF THIS PfiOPERTV TO PERFORM THE WORK FOR WHICH <br /> — APPIICATION IS MADE AND I COMPLY WITH l"HE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �1l� ���� //-i- 9i <br /> sicrvanat °"'� <br /> PqOJELT ADDBE55 <br /> C etE ( c�rveusmrssucer+sir�o <br /> ��� MECM�NICAL <br /> qp, TYPE OF flKTUNE OR ITEM FEE N0. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A�HNDLG UNITS—ri.P. __ <br /> BATHTUB ' FORCED AIR SYSTEM6—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) /b � — UNIT HEATERS—B.T.U. M _ <br /> SHOWER — CLOTHES DRVERS <br /> KITCHEN SINK 6 DISP � VENTILATION FAN __ <br /> DISHWASHER RANGE HOOD <br /> UUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ' , <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DfiINKING FOUNTAIN � FIREPLACE INSERT � <br /> FlOOR DRAIN � HEAT PUMP <br /> B�CKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS ExHAUST FAN <br /> SINK(SERVICE--BAR,ETC.) � <br /> T <br /> i <br /> SUB TOTAL S / � SUB TOTAL $ <br /> PERMIT 5 /O � FEFMIT $ <br /> TOTAL FEE $ f '� l OTAL FEE � <br /> FOR OFflCE USE ONLY: <br /> FRONT SETBACK RERP SETBACN SIDE SETBACK PLAN CHECN NUMBER FEE FECEIPT N0. <br /> USE ZONE LOT AREA VACANT SITE ��S VALUI�TION FEE <br /> BUILOMG � <br /> flPE Of CONiS ALIOWpBLE IYPE Of CONST.AGiORI oaUmNt� No a mrtumG uH�.�s � <br /> caouv pLUMeING 3.�'"� <br /> 52E OF BIDG. NO OF STORIES BASEMENT MECHANICAL <br /> OCCUPANCY LOpD FIRE SPRNKLEFS AEO'D HEIGHT UMITATION <br /> ADDiTIONAL PIAN CHECK <br /> SPRINKLER � <br /> ---T— <br /> REp50N FOR SPRIFIKLERS <br /> STAT[BUILDING SURCHAPGE <br /> INTRNE BV PLANS APPPOVED BV CITY OF EVERETT PUBLIC WORKS <br /> LOCAL 8ALE8 � <br /> TIUI CODE IS 3105 T�*�� �� �°'� <br />