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APPLICATIO� FOR CONSTRUCTrJN PERMIT everett <br />�E�� TO BE COMPLETED IN INK—PLEASE PRINT � <br />cmr oF <br />everett HEATING SYSTEM: ❑ GAS O ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING fj�MECHANICAL ❑ PWMBING G SIGN <br />pWNEq MAILAD�flESS CITV ZIP PMONE <br />TENANT MAILADDRESS CITY ZIP PNONE <br />Tl �� _r _ . .\ � _ �.�1� �/� _�nT.� OI � � �.I�Lh_�ci � I. � <br />MDRE55 <br />FL11L <br />CONTRACTOR MNLADDflE55 <br />�� <br />NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR <br />pqpPO�SJE'�D �US.E �OF B�UILDINO <br />�1`7' � T-��� <br />LEG/�L DESCRIPTION OF PROPERTV (SHOWN BELOV <br />LOT BLOCK OF <br />BATHTUB <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAIN^r-RAIN <br />FOR OFFICE USE ONLY: <br />FpONTSETB�CK RERRSETBACN <br />TYPE Of CONTS. ALlOW�9lE <br />SRE OF BLOG. <br />OCGUPANCYLOAD <br />REASON FOR SPRINNLEFS <br />PERMIT $ <br />TOTAL FEE $ <br />LOT AFEA <br />TVPE OF CONSi. RCiWI <br />NO.OF STORIES <br />FIPE SPRNKLERS REO'D <br />PIAN^u APPROVED BY <br />SETBACK <br />CITV ZIP <br />CITY ZIP <br />92t� �I�+ <br />CITY 21P <br />>� t�c ZRh <br />CITV ZIP <br />PHONE <br />PMJNE LICENSE+/ <br />869— �f2.3?z_ <br />PXONE LICENSE� <br />£�9ia� t,w, rs <br />PHONE � LICENSEI <br />r7 DEMOLITION ❑ WOODSTOVE/FRPL INSERT C' BUILDING RELOCATION <br />� CONTACT PERSON AND PHONE NO. <br />I HEREBY CEFTIFV THAT � HAVE FEAD 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 P9ESUME TO �IVE <br />AUTHORITV 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CXON�O LA�W AND 296200 WAC. <br />SIGNA RE MCT RIZED�OENT DATE �/L�I <br />, v <br />D7 ) �3 _u.�1-���-�Ps�M , X� <br />APPLICANTSCmBUSINESSIICENSENO.IW�Bu5P1ESSNAME � <br />NO. � TYPE OF EOUIPMENT FEE � <br />A/CrA/HNDLG UNITS--H.P. 2-/t} �- � <br />FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br />UNITHEATERS-B.T.U. M ___� <br />CLOTHES DRYERS ' . <br />VENTIUITION FAN I -� <br />RANGEHOOD � <br />WATER HEATER ' <br />� <br />WOOD STOVE � � <br />METAL FIREPLACE 8 CHIMNEY ' <br />FIREPLACE INSERT � �- <br />HEAT PUMP ' � <br />GAS PIPING � � <br />EXHAUST FAN ' ., <br />i <br />- � <br />� <br />� <br />`_ <br />SUB TOTAL $ <br />� <br />PERMIT $ i <br />TOTAL FEE $ <br />PLANCHECKNUMBEF FEE RECEIPTNO. � <br />BUILDING <br />OLCUPUlCY NO.OiVNEIIINGUNItS <br />GPWP p�UM81NG <br />BASEMENT MECHANICAL <br />HEIGM7 L�Mi7AnON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 �TAL <br />N <br />n <br />