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APPLIC�iTIC`y11 FOR CONS'�RUC'i~JN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS �ELECTRIC ❑ <br />BUILDING DEPAR7MENT <br />259-8810 <br />DEMOLITION i J COMBINATION I BUiLDING � WECHANICAL ! I PLUMBING I I SIGN <br />O�JER IAAILAD[1REgS /� GTV ZIP PHONE EI f VG <br />�/ P�A7 /�- / i� i %n /%�,�i` � �C�S /-�� �' 1/� S� S,f� .��n '�i,r-�� � <br />Ilr.,?A/J�'a <br />TENANT MAILADORES� —��— CIN ZIP PHONE <br />ARCHITECTOflDE51GNER � MPILADDRE55 <br />GENERALCONTR�CTOR MAILAD�RE55 <br />lAAIL <br />MAIL <br />CITY / ' ZIP <br />CITY <br />�/ -1 s��� � <br />CITY <br />�S�/:� /� • (� � <br />e,'�/o- @3'�62-10 <br />CLA55OF WORK <br />I I NEW ;' ADDITION S� ALTERATION .! REPAIR <br />00 <br />CONTRACTPRIGEOFWORK ��U� ��OU. __ <br />DESCRIBE WOHN AND SOUARE FCATAGE INVOLVED <br />�- i TD%J j�,v. f-s '! L��',�- u r <br />PflO�POJSED 115E OF BUILDING /� <br />I f���� n� - /< rz 7,4i / — <br />LF.GnL DESCRIPTION OF PROPERTY (SHOW N BELO W OR ATTACH FOl1F COPIE,-•� <br />LOT BLOCK Of <br />%�x -� D�.��DS—.�-0�7_ <br />AD�fiESS <br />TYPE OF FI%TURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHtN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRA�N <br />BACKPIOW PREVENTERS <br />ROOF ORAINS-RAINLEAC <br />SINK (SERVICE-BAfl, ET( <br />SUB TOThL 5 <br />PERMIT i <br />FOR OFFICE USE ONLY: <br />FflONTSETBACK FEARSETOlCK <br />USEZONE LOTAREA <br />iVPEOFCON75.ALLOWPBIE TYPEOFCONSi.ACiUAL <br />SIZEOFBLDG. NO.OFSTORIES <br />OCLUFANCYLOAU FIRESPflNKLER5RE0'D <br />REASON <br />INTAKE BY I PLANS APPROVED BV <br />SIDE SETBACK <br />VACANTSITE <br />PHONE <br />�HOI�Ea��,� _�S/�TE LICENSE u <br />+�l,dc.� �.C.J/1 C07797 <br />PHONE STATELICENSEa <br />���_� •�r/ C 1 <br />PHONE STATE LICENSL k /S <br />a <br />DEMOLITIDN ��.. ��. WOODSTOVE/FRPL INSERT I� BUILDWG RELOCATION <br />CONTAGTPERSONAND NONENO. dO� � <br />�rtX�A �f=T/c'IC'K /„2�r-�n3�.� <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A'PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PRG:�ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OFl <br />NOT. T1iE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOR'TY TO VIOLATE OR CANCEL THE PR7VISIONS OF ANY <br />OTHER Sl'ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER ��F THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br />APPLIC/�TION IS MADE AND I COMPLY WITH THE STATE <br />CONTR<,CTORS LAW 1827 RCW AND 296200 WAC. <br />MECHANICAL <br />FEE NO. TYPE O� EOUIPMENT <br />� AIC-A/HNDLG UNITS-H.P. <br />� FORCED AIR SYSTEMS-B.T.U. M E.A. <br />i UNIT HEATERS-d.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />� METAL FIREPLACE & CHIMNEY <br />; FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />i EXHAUSTFAN <br />6UILDING <br />amvu�a uoarowEwr,cusus <br />caow ' PLUMBING <br />BASEMENi MECHANICAL <br />HEIGHTLRAITATION /+ODITIONALPLANCHECK <br />SPRINKLER <br />STATE BUILOING SURCHARGE <br />CITY Of EVERETT PUBLIC WORKS <br />LOCALSALEa <br />TAX CODE IS 3105 TOTAL <br />FEE <br />PERMIT <br />TOTALFEE <br />� <br />� <br />E <br />FEE <br />i <br />� <br />i <br />