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APPLICATIC� l FOR CONSTRUCT�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ,� SIGN <br />ZIP �'nune <br />GENERALCONiPACTOR MAILA��BESS CITV ZIP PHONE STATELICENSE/ <br />�L(1M �iEDN �NC PD-84xSz69 CyNN�eon `�R��� �76-�35- C�E�zRy n,c.o�� �n� <br />MECNANICALCONTPACTOR MAILADDFlE55 CITY ZIP PHONE STATELICENSE� <br />PLUMBINGCONTRACTOfl MAILAUORE55 CITY 21P PI10NE STATELICENSE� <br />PqICE OF N�RK <br />//r Q� <br />INVOLVED <br />PROPOSED USE OF BUIIDING <br />SQ�`:k��a.�./ P(l_ <br />LEGAL OESCRIPTION OF PROPEfliV (SHOWN BELOW OR ATTACM 7W0 COPIES) <br />LOT 9LOCK OF <br />PRRCELTA%I.D.NUMBER <br />3930 •-000- D2! — <br />CONSTRUCTION LOAN �ENDER, ADUflESS, <br />DRAIN <br />fl00F <br />i'IXTURE <br />FOR OFFICC USE ONLY: <br />FRONTSETDACN _ REAi� <br />USEZONE <br />iVP�CONS� <br />SRE OF BLDG. <br />INTANE BY <br />LOT AflEA <br />NUMOER <br />TOTAL $ <br />NIT $ <br />1L FEE $ <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 TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFiOVI510N5 OF ANY <br />OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 />CONTRACTORS LAW 1827�CW AND 296.200 WAC. <br />N, . �(/ " V 7 ^/ <br />VN�\_ <br />LIGNA �u �n l_ 0 E <br />l� b <br />cnr ousmess u�sc <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMEkT FEE <br />, FV�A/HNDLG UNITS—H.P. <br />� FOfiCED AIR SYSTEMS—B.T.U. M E.A. <br />; UIJIT HEAT[RS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />� WATER HEATER <br />, WOOD STOVE <br />� METAL FIREPLACE (WOOD �URNING) <br />' FiREPLACE INSERT <br />� HEATPUMP <br />' GAS PIPING <br />� EXHAUSTFAN <br />;g $IOE SETDACK PLAN Gntcn nomocn <br />• !! �/ <br />VACANT SITE ` FEES <br />❑ YES ❑ ND BUILDING <br />IE$ OLLUPANCY MO.OiVd'fIIIHGU11115 <br />cnav pLUMBING <br />FIPESPRINKLERSflE�'0 OASEMENT AIECHANICAL <br />FINE <br />PLANS <br />DATE <br />❑ YES ❑ NO <br />IEOD MEIGHTLIMITATION <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />VEO BY CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />.�. l� TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE � $ <br />� <br />N <br />