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APPLICATIQ"'' FOR CONSTRUCT''1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ,J GAS J ELECTRIC ] <br />259•8810 <br />i_] DEMOLITION Cl COMBINATION ' I BUILDING ❑MECHANICAL �PLUMBING � I SIGN <br />OWNER 'CIAAILAD�RESS CITV ZIP FNONE <br />TENAN�r ��� M 1�nD�S� ��� �G�TV � 21�I ,�E-��I I <br />�nCHnITEC70.FlDcEySIGN`EF M�AILADDRE55 CITY Q21P!` ! °HOtlE r <br />,'/� KJON�-C_%1 NR Z�M�LiL ADDRE55 L�� �T � �UZv 1 " P Z E Z I 7� / STATE L�CENSG r <br />11�C�.����(,� �ZI M�idua5 �cl. ��T� -�'/£�'Z�ic� 3�!-?�9<S' Mcc����/o��� <br />MECNANICALCONTRAGTOR M�IL�DDPE55 GITV ZIP PHONE STATELICERSEs <br />PWldBMG�NTRACTOR MAIL ADDRE55 , QTV 21P PHONE STRiE UCENSE � <br />CONTRACT PRILE OF WORK <br />UESCFIBE WORK ANO SOUARE FOOTAGE INVOLVE� <br />l � eJt�a.9T 1 `�'t-(72pve� <br />PF�POS DU EOFBUILOING���`C� <br />1�1 <br />LEG4L UESC9 IPTION OF PROPEFTY��' IS///MyyyOWCN BELOW OR <br />LOT `"' BIOCK �=- OF� <br />io.Nurnnen <br />o -6g5 - � _ <br />ION LOAN IENDER, �DORESS. TEl <br />PLUMBING <br />0. TYPE OF FIXTI <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY(WASH BA£ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />I.AUNDRYTRAY <br />CLOTHES WASHER <br />URINAi <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />�ACKFLOW PREVENT <br />ROOF DRAINS—RA'NI <br />SINK ISEFVICF--BAF, <br />�Z <br />NIIMBEH <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT.:tTBAC1c REARSETBACK <br />USEZONF IOTAPE� <br />iYPEGFCONSi. NOAFSiORIES <br />SR[ OF BLDG. FIR[ SPNINKlEPS PEO'0 <br />OCCUPANCY LO�D FIRE AIARM RW D <br />RE�SON <br />INiAHE �Y PLANS APPPOVED BV <br />D41E <br />�o,�;C%�'(� �S�i.��`�� No. �i3 �1—?,65 f� —�'> 84- 883� <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AN� CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />COPIES� WORK WILL BE COMPLETED WITH WHETIIER SPECIFIED NEREIN OR <br />�.-� — NOT. THE GRANTING OF 4 PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO ViOLATE OF CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR IOCAL LAW REGL'LQTING CONSTRUCTION OR THE <br />PERFORMANCE OF ^ONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS M�1DE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />� 7-i � ' <br />1 S�fN41Uf1E ���� <br />f�K CIIYOOSi�I55UCEN5CH0 _ <br />FEE <br />0 <br />N0. TYPE OF EQUIPMEN7 ree <br />A�C—A/HNULG UNITS—H.P. <br />fORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATEPS—B.TU. M � <br />CLOTHES DRVERS ' <br />VENTILATION FAN <br />RANGEHOOD <br />WATEF HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIi7EPLACE INSERT <br />HEAT PUMP <br />GAS PIPING � <br />EXHAUSTFAN <br />SIDESfTBACK PLANCI�EG h <br />/ J t <br />V <br />vncnNrsrte FEES <br />i i YES �� N� BUILDING <br />occursva uanvo•.vnuncve�rs <br />ewouv PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES � NO <br />HEIGHT LIMIT�TION ADDITIONAL PLAN GHECI: <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETf PU�LIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S , <br />PERMIT $ <br />TOTALFEE S —� <br />NO. <br />/, <br />