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�� APPLICATIQ"` FOR CONSTRUCT;7N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS (] ELECTRIC ❑ <br />259-8810 <br />I I DEMOLITION ❑ COMBINATION C � BUILDING 17 MECHANICAL ❑ PLUMBING �iSIGI <br />TENANI <br />MAILADUflESS CITV ZIP PHONE <br />)�,�,Q IG�IS �'���SE �V��i 9�Z05 206- 353•-"1-70p <br />MAILADDRE55 CITY Z�F <br />McN�L �Z10 �vF�G�N �-'A-`( �/52�3 <br />PNONE <br />206 - 355-7200 <br />OR DESIGNER MAIL ADDRESS G7Y ZIP PHONE <br />lJEA�,X SI(�I�K (�j23 ��/ERU�+t�n� 0l. �JgZv3 2ob-3S3-sT47 <br />MAILADORE55 GTY ZIP PnorvE sinie�wenoen <br />JGr 2Ry10 W�SGoJ��► Ftk�N47»M `��St23 `13S^2o°�y �Ou6StMo7�(JIG <br />MECHANICALCONTRRCTOR MAILADDRE55 <br />PIUMBINGCONTRACTOR MAILADOFE55 <br />CONTqA��RICE� WpR� <br />O ��s <br />DESCRIBE WONn AND SOUAPE FOOTAGE INVOLVED <br />CITV <br />CITV <br />PROPOSEL USE OF BUILDING <br />�iZA�/GL PcC�EnrCs� <br />LEGAL UESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBER <br />CONSTPUCTION LOAII LENDEF, ADDRE55, TE�EPHONE NUMBER <br />NO. <br />WATER <br />OR ITEM <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />use zoNe <br />G -� <br />iYPE OF CONST <br />SIZE OF BLOG. <br />OCCUPANCYLOAD <br />REASON <br />INTAKE BV <br />SUB TOTAI S <br />PERMIT $ <br />TOTALFEE $ <br />FIRE SPRINNLERS REO'D <br />DATE <br />BY <br />SIDE SETBACN <br />21P PHONE <br />ZIP PHONE <br />CONTACT PEflSON AND PMONE NO. <br />STATE LICENSE C <br />�j,2.$ LfNOC� 353-ST�f7 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 1'O GIVE <br />AUTHORITY TO VIOLATE OR 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 />OWNER OF THIS PROPERTV 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 />OF E�UIPMENT <br />FORCED AIR SYSTEMS-B <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPL/,CE (WOOD <br />FIREPLACE INSERf <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />❑ YES IC'�r0 BUILDING <br />OCCuopHCv HOOiU1VflLINGUNItS —� <br />�AOUP PLUMBMG <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGNTLIMITATION ADDITIONALPLANCHECK _ <br />r OTHER <br />STATE BUILDING SURCHAFGE <br />CITY OF EVERETT PUBLIC �^10RKS <br />LOCALSALES <br />rer r.nnFis 3tos TOTAL <br />�_�_s� <br />o�re <br />FEE <br />� <br />M F.A. ' <br />� <br />T <br />� <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTALFEe . $ ' <br />n � <br />FEE NECEIPT NO. <br />VALUATION FEE � <br />— �— <br />_ i <br />i <br />i <br />i <br />=�! 6� <br />� <br />i <br />i <br />�� <br />i <br />� <br />/ 0 ; C�� <br />