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APPLICA�TIQ'-! FOR CONSTRUCT'�1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEA G S <br />BUILDING DEPARTMENT TIN YSTEM. ❑ GAS ELECTRIC I] <br />259-8810 <br />� DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �PLUMBING ❑ SIGN <br />OWNER MAILA��RESS CITY 21P � pup NE <br />l� /% . �l . . . 11 /71YJ. <br />TENpNT <br />GENERALCONTRACTOR <br />�l3 �C Lo <br />MECHANICALCONTRACTOP <br />MAIL ADOflE55 <br />MAIL AD�RESS <br />�-� y y. i...r d�L 6/ <br />I <br />CONTRACT PRICE OF WOflK �(-� /� <br />w-J �OL/ i� <br />�ESCFIBE WORK AND SOUARE FOOTAGE INVOIVED <br />OF <br />� CITV <br />CITY <br />CITV <br />�// G r <br />CITY <br />CITY <br />LEGAL �ESCRIPTION OF PROPEflTY (SHOWN BELOW OR ATiqCH TWO C04'E5� <br />�er BLOCN oF <br />PARCELTAXI.D_NUMBER <br />LONSTRUCTIONLOANI.ENDEfl.ADDRESS.TELEPHONENUMBEF <br />NO. TYPE OP PIIfTURE OR ITEM <br />. WATER CLOSET (TOILET) <br />' BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN � <br />BACKFLON'PREVENTEflS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK SIDESETOACK <br />USE 20NE <br />TVPEOFCONSI. <br />� <br />SIZE OF BLOG. <br />LOAD <br />flE�50N <br />INiAKE BY <br />FEE <br />ZIP PHONE <br />21P PHONE <br />ZIP PHONF/ STATE <br />w 6� 6 7y3-3 �U ccowi <br />��P PMON�IELICENSE%jp/ <br />[/ [ <br />ZIP PNONE STATE LICENSE p <br />CONTACTPERSONANDPHONENO. / �u..��i <br />i HEREBY CERTIFY THAT I HAVE�J(b AND EXAM�NED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TF:IS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE Orl 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 />OW!JER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x ��� ��-� `> ���/�3 <br />SiGNATUPE pRE <br />LITY 809NE55 LIL[NSE NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />A/�AJNNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN ; <br />RANGEHOOD � <br />WATER HEATER � <br />WOOD STOVE ; <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT . ; <br />HEAT PUMP � <br />GAS PIPING ; <br />EXHAUST FAN � <br />LOT AREA VACANT SITE FEES <br />L� YES ❑ NO BUILDING <br />NO.OFSTORIES pCCu��Ntr NOoipWFLlIr�6uN115 <br />� �A� uQG� PLUMBING <br />FIRESPpINKLER5RE0'D BA EMENT MECHANICAL <br />AfO ❑ YES � NO <br />FIflE ALARlA REO'D HEIGHT LIMIIATION ADDITIONAL PLAN CHECK <br />� OTHEH <br />STATE BUILDING SURCHARGE <br />PLANSAPPqOVE�BV CITY OF EVERETT PUBLIC WORKS <br />CW� LOCAL SALES <br />onTe h_IN�A-� TAX CODE IS 3105 TOTAL <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />Yp <br />A <br />i <br />