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- APPLICAT14.1 FOR CONSTRUCTr)N PER�IAIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />C I DEMOLITION I=1 COMBINATION <br />fJ BUILDING <br />crtv <br />'O aa �s <br />❑ MECHANICAL ❑ PLUNBING ❑ SIGN <br />PHONE <br />TENANT MAILADDRE55 CITY ZIP PHONE <br />ARCHITECTORDESIGNER MAILAO�FE55 CITV ZIP PHONE <br />GENEPALCONTflACTOR MAILADORESS CITV 71P PHONE STATELICENSE� <br />ME HANICALLOHiflqCTOF <br />o/✓a� e�� / <br />P W MBING CONTRACTOR <br />� <br />ZIP PHONE <br />STATE LICENSE N <br />CLA55OF WORK <br />❑ NEW ❑ ADDITION I � ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVEIFflPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PBICE OF WORH <br />DESGRIBE WOFK AND SOUARE <br />� ��� <br />PROPOSEDUS BUILDI G <br />C_ <br />LEGAL DESCflIPTION OF PROPI <br />LOT BLOCK <br />PROJECTADDRESS <br />n.7�1 <br />INVOLVED <br />OF <br />N0. TYPE OF FIXTURE OH ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERV�CE—BAR, ETC.) <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />ttPE Of CONiS. RLLOWAOLE <br />� <br />SIZE OF BLUG. <br />�2,31Z yF <br />OCCIIPANCVLOAD <br />PEA ON FOR SPRINKLEF <br />DRt�, <br />INTAKE BY <br />LOT AREA <br />iVPE OF CONST. ACN�rAL <br />�' I flf <br />NO.OF STORIES <br />FLANS APPPOVED BY <br />COPIES) <br />SIDE SETBACN <br />JANDPHONE <br />/L � <br />i HEREBY CERTIFY THAT I HAVE READ AN� EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OfiDINANCES 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 CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� <br />�. .� , - /a �� 9a <br />SIGNAT <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 HEATER <br />WOODSTOVE _ <br />METAL FIREPLACE & CFi�MNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />`�/LO <br />BUILDING <br />occuru+cr xa.orowewxcuxrts <br />��2 �7 PLUMBING � <br />BASEMENT MECHANICAL <br />HEIGHT LIMIT�ON � P�N CIiECK <br />SPRINKLER <br />STATE BUILDING SUFCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />RECEIPT NO. <br />FEE <br />33 y� <br />