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APPLICATIC"�] FOR CONSTRUCT'-1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION G BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEF MAILA�DRE55 CIiY ZIP PMONE <br />y�ni.✓rs ��:�� �-os G�t-r3�1 /l/� .�r`Y�:T 98zni zs8- �6:s#3 <br />TfNANT A4111 ADORE55 CITY 21P PHONE <br />�RCNRELT OR DESIGNEB <br />GENERALCONiRACTOR MAILAODRE55 <br />CITY ZIP PHONE <br />21P PHONE STATELICENSEa <br />MECHANICALCW�TflRCTOR MAIL�DDRE55 dTV Z�P PNONE STATELIGEHSER SH � <br />.�7r/iE�J /�g9n.JG /7v.7 C/iE�rniU; '�8 fYE��'TT �Lo / 3S3•33`f/ �+�1'��Rx- <br />VLUMBINGLONTRRCTOR MAILADDHE55 CITV ZIP PNONE STATELILENSE• <br />CONTRACT PPICE OF WOHK <br />2 90 "' <br />DESCRIBE MlORK AND SWRRE FOOiAGE INVOI.VEO <br />PROPOSED USE OF BUILDING/� <br />a� <br />LEWL DESCRIPTION OF PROPERTV �SNONT! BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARLELTA%I.O.HIIMBER <br />CONSTRl1CT10NLOANLENDER,ADDRESS.TELEPHONENUMBER <br />PROJECTADDRESS <br />� C'OGf3� <br />PLUMBING <br />NO. TYPE OF FIl(TURE OR REM FEE <br />WATER CLOSET (TOILET) � <br />BATHTUB i <br />LAVATORY (WASH BASIN) <br />SHOWER ' <br />KITCHEN SINK 8 DISP <br />� DISHWASHER ' <br />LAUNDRYTRAY ' <br />—i <br />CLOTHES WASHER � <br />URINAL ' <br />DRINKING FOUNTAIN � <br />FLOOR DRAIN ' <br />BACKFLOW PREVENTERS � <br />ROOF DRAINS—RAINLEADERS ! <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSETBRCK <br />USEZONE <br />7YPF OF CONSi. <br />SIZE OP BLDG. <br />OCCIIPANCV LOAD <br />REASON <br />INTAK@ BY <br />SUBTOTAL 5 <br />PERMIT $ <br />TOTAL FEE $ <br />SIDE <br />LOT AREA <br />NO.OF STONIES <br />FIRE SPRINKLERS REO'� <br />FIPE A1 ARM PE00 <br />PL1N5 APPROVEO BV <br />DATE <br />VACANT SITE <br />❑ ves ❑ No <br />acun�xcr xo a mnuixcuxirs <br />tHwn <br />�ASEAIENT <br />❑ YES ❑ NO <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTACT PENSON AND PMONE N0. <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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PFi0VI510NS OF ANV <br />OTHER STATE OR LOCAL LAW REGULAlING CONSTRUCTION OR THE <br />PERFOflMANGE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM 7HE WORK FOR WHICH <br />APPLICATION ADE AND I COMPLY WITH THE STATE <br />0 TRACTO LAW 1.27 RCW ANJz296200 WAC. <br />-/� F3 <br />5'i.N4iVf1E DAiE <br />ci*v eusmEss iw[Hse rvo. <br />!VC—lvHNDLG UNITS—H.P <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPL <br />FIREPLACE INI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />PIANCHECK <br />BUI�OING <br />PLUMBING <br />MECHFNICAL _ <br />hODITIONAL PLAN CHECI�. <br />OTHER _ <br />STATC- OUILDING SURCHA(iG[ <br />PUBLIC WORHS <br />TOTAL <br />FEE <br />SUB TOTAL $ y� <br />PERMIT 8 �° <br />TOTALFEE $ ���oo <br />