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APPLlCATI(11 FOR CONSTRUCT��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �HEATING SYS7EM: ❑ GAS ❑ ELEC7RIC ❑ <br />259-8870 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWN[fl /� MAILARDq�[f55 I 6 CI{T�V ZIP /P/1pNE � / <br />��IC'yl_��=4\' �1.� I)�I\ l v�l� ��Q`� l�/J'1��` �llr 16��.J � l _ �. � <br />TENANi MAIL ADDRE55 p1TV ZIP PHONE <br />S�h+�� qt I�tiuvA <br />RRCHITECiORDESIGNER MnI�ADDPE55 CItY 21P VHpNE <br />GENERALCONTRq�TpR MAILADDRE55 CITY ZIP PHONE $TATELILENSEI <br />S�•a as Abn� c <br />MECHFNICAL CONTRACTOR M�IL �UDRESS CITV ZIP PMpNE STATE IICENSE � <br />PLUMBINGLONTRACTOR MAILA��RESS CITY ZIP PHONE SiATEUCENSE� <br />CONTfl�Ci PRI�E OF WORK <br />UESCFBE WORK ANO SOURRE FOOTAGE INYOLVED <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY �SMOWN BELOY/ OR ATTACN TWO COPIES� <br />LOT BIOCK OF � <br />.i�l� �-(�� <br />I.D.NUMBEP <br />�CJ -�)Ga -OG�.�. <br />ON LO�N LENOER. ADUNE55, TELEPf <br />rnooRes.s� /� <br />L <br />BING <br />TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DFAINS-RAINLEADERS <br />SINK (SERVICE-BAR. ETC.I <br />.r� <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FPONTSETBACN REARSET�ACH <br />USEZONE LOTFREA <br />ttVCOFCONST NO.OFSTOflIES <br />SIZE OF BLOG. FlRE SPRINKLENS REOD <br />OCCUPANCV LOAD FIRE ALARM REO'D <br />INTAHE BY <br />PLANS r1PPROVED BY <br />DATE <br />FEE <br />CONTACT PERSON ANO PMONE N0. <br />I IIEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TH� SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COA7P�ETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE Oti CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGUTATING 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 />CONTqACTORS LAW 18.27 fiCW AND 296.200 WAC. <br />� ��-�1/a . �,J� -t,� ' 7-��-�'�, <br />SIGNEIUflE —�— o�*e <br />C��Y BUSM[SS I�CFNSE NO <br />MECHANICAL <br />NO. TYPE OFEOUIPMENT FEE <br />A/�A/hNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATEH � <br />WOODSTOVE i <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACEINSERI" ; <br />HEAT PUMP i <br />G.AS PIPING ! <br />SIDE SETBr1CK PLAN CHEGR NUMBER PEE <br />'��y�9 <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />DSUI'ANLY NOMDWlIUHGIIHIR <br />cnouv FLUMf31NG <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEiGHi LIMIinTION ADDITIONAL PLAN CHECK <br />OiHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ ' <br />PERMIT $ ; <br />TOTAL FEE $ � <br />RECEIP7 NO. <br />bn <br />0 <br />b <br />