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APPLICATI�-' FOR CONSTRUCTt'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM J GAS J ELECTRIC J <br />BUILDING DEPARTMENT - <br />259-8810 <br />DEMOLITION COMBINATION BUILDING ! MECHANICAL PLUMBING SIGN <br />ONTIER � MAIL AODAE55 � GITY ZIP PMONE <br />�� /—a �- rY w s'o ,� � i�, l�, v L J� �� 1 fI �,{-,�.� s �7 s`Y- � s�5'Y <br />TENANT M ADDRE55 T�' ZIP PHpNE <br />�dA1L AODRESS <br />GENERnLCIN1iRnGiOR MAILADDRESS GITV 2iP PHONE STRTEL�C[NSEY <br />MECHANILlLLCONiRACTUR MAILApDRE55 GITY ZIP PHONE STRTELICENSE• <br />PLUMBING CONTRACTOR MAIL ADDRE55 GITY 21P PHONE STRTE LIGENSE � <br />GONTRACT PFICE OF WORK <br />DESCFIBE WORK pND SOURRE fWiAGE INVOLVED <br />/r l-a — <br />�p NJp,_ <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION Oi PROPERN �SHOWN BELOW OR ATTACH iW0 CO'IE51 <br />LOT� BIOGK GF � C✓' C <br />,% / i <br />PFFCELTA%10 NUMBEfl <br />GONSTRUCTIONLOnNLENDER.ADDRESS.TELEPNONE NUMBER <br />WATEF CLOSET (TOIL <br />BATHTUB <br />LAVATORV�WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DFiAIN <br />ROOF <br />SINK 1 <br />SU8 TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONiSETBnCK REARSETBACK <br />UuE20NL LOTpREA <br />iYPCOFCON57. NOAFSTORIES <br />$RE OF BLUG fIRE SVRINKLERS RE0'D <br />Di..^,UVANCV LOAD FIRE 4LARM R[00 <br />REASON <br />INTANE BY <br />DATE <br />ev <br />FEE <br />CONtACT PERSON AND PNONE NO. <br />i HEREBY CERTIFY THAT I HAVL READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS TVPE OF <br />WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OF <br />r NOT. THE GRANTING OF A PEFMIT DOES NOT PiiESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />— PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERN TO PERFORM ?HE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />IrJ � <br />i �: / <br />.. /�n/_ =-��1_Il., r,/S 19i� <br />N0. TVPE OF EOUIPMENT <br />A/C—A'HNDLG UNIT&—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEfl <br />WOOD STOVE <br />METAL FIREPLACE IWOOD �URNING) <br />FIREPLHCE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SI�E $ETBACK PL�N GHEGN Nl1M8EF F[E <br />VACANT SITE FEES <br />. YES � ' NO BUILDING <br />OLNF�4C� H00!CW[WMGIINi15 <br />r=;,uo p�UM61NG <br />BASEMEHT MFCHANICAL <br />li YES -, NO <br />i+EiG��r uMrtqnGN A�DIiIONAI PLAN CHECK <br />OTl1ER <br />S7ATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 70TAL <br />0 <br />0 <br />SUBTOTAL $ ' <br />PERMIT $ � <br />TOTAL FEE $ <br />PEGE PT N0 <br />