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APPLICATIC"�l FOi� CONSTRUCT'lN PERMIT � <br />TO SE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ _� <br />259-8810 <br />❑ DEMOLITION CI COMBINATION ❑ BUILDING �MECHANICAL C PLUMBING ❑ SIGN <br />O ILA�DRESS Cltt I PHONE y��'i� <br />�,�,V. `rih��,�,,,, `�CI1 (��uPr i.� ► h �,-1- �i�St.203 3�5 � <br />TENRNyT'� MAIL A�DPE55 <br />1 \ `� <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />M�IL AODRESS <br />CIP/ � ZIP <br />CITV ZIP <br />CITY 21P <br />CITY IIP <br />GTV ZIa <br />CONT T PRICE O W NK <br />a 3. o� <br />DESCRIBE WORK AND SOUARE FOOTRQE INVOLVED CONTACT PERSON NID PMONE NO. <br />rt�'1�C�cCA\\ 1��h G�t ��l.i 1 Y� <br />LEGRL DESCFIPTION OF PflOPERTY �SHOWN BELOW OR ATTACH TWO COPIES) <br />LpT BLOCN OF <br />P�RGELTA%I.D.NUMBEfl <br />GONSTRUCT17N10�N1.EN�ER.ADDRE55,TELEPHONENUMBEfl <br />PRO�►� A DRF�S�� V � \� �� <br />�� i�� <br />ALUMBING <br />NO. TYP[ OF FIl(TURE OR ITEM <br />WATER CLOSET�TOILET) <br />B.ATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />� D!SHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />flOOF DRAINS--RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FflONTSETBACK NEANSET <br />USEZONE IOTARE� <br />lVPE Of CONST. <br />SIZE OF BLD6. <br />OCGUPANCYLOAO <br />REASON <br />INTAKE BY <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FIflE SPRINNlEflS flE0'D <br />DA1E <br />APPROVE� BY <br />PMONE <br />PHONE STRTE LICENSE / <br />PHONE ST�TE LICENSE II <br />PNONE STATE LICENSE / <br />I HEREBY CERTIFY THAT I HA�:E READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF L4WS AND ORDINA�!CES GUVERNING THIS TYPE OF <br />WORK WII.L BE COMPLETED WITH K'HETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI7 DOES NOT PFESUME TO GIVE <br />AUTHORITY TO VIOLATc 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 TI�IS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT!pN IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTOHS LAW 1827 RCW AND 296200 WAC. <br />x ��iUlt� 7.���(/kX�1�7-/7.�/�' CP�� 7%,lT <br />5p�� DAIE <br />CiiV BOSME59lICFNSE W <br />MECF'�>NICAL <br />�0. TYPE OF EOUIPMENT FEE <br />AI�A/HNDLG UNITS—H.P. � <br />( FORCED Alfl SYSTEMS—B.T.U. M E.A. ; <br />UNIT HEATER5—B. <br />CLOTHESDRYERS <br />VENTILATION FAN <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIFEPLACE IDISERT <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETBACK PIAN GH'[/GK rvU/MtltN <br />H��J � <br />❑ YES ❑ NO BUILDING <br />acuverar xoaowcuixcuxrts — <br />cnwv PLUMBING <br />BASEUEnT MECHANICAL <br />❑ ves n No <br />HEIGNTUMITaTION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUII.DING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TN( CODE IS 3105 T�TAL <br />$ iU ' � <br />$ � <br />. i_.�. � <br />