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APPLICATI�J FOR CONSTRUC�'JN PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT <br />259-8610 <br />HEATIIJG SYSTEM: ❑ GAS ❑ ELECTFiIC iJ <br />COMBINATION BUILDING <br />�� S M � � �' n+na ao��s <br />� 3f r <br />TEN�NT MqILA00PE55 <br />4RCHRHGT08DESIGNER ldqILADDRE55 <br />�or <br />WNTpACiOR <br />SS OF WORK <br />NEN� '� ADDITION <br />TRACT PRICE OF WORN <br />OF PpOPF <br />_ BLOCK <br />PROJECTADDF�ES•S��'� <br />� =�" <br />PLUMBING <br />NO. TYPE OF <br />�_ WATER CLOSET <br />BATHTUB <br />v� • s ��; <br />MAIL ADDflESS <br />MAIL ADDRESS <br />S� ��1' <br />. ALTERATION <br />'4GE INVOLVED <br />�� <br />SNOWN �ELOW OR AT <br />OF <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF <br />SINK l <br />OR ITEM <br />SUB <br />FOR OFFICE USE ONLY: <br />FflONTSETBACK REARSETBACK <br />USE ZONE � OT AREA <br />IYPEOFCONiS.ALLOYlABIE 7YPEOFCONSi.ALNAL <br />S¢EOFBLDG. ND.OFSTOPIES <br />OCCUPANCYLO�D pRESPFNKLERS REO'D <br />flFA$OY FOR SPRI1 <br />INTAKE BY <br />BV <br />-i7�/G s�� <br />� ,�'LS�v <br />REPAIR <br />JTAL $ <br />i S <br />FEE S <br />MECHANICAL <br />ZIP � PF <br />t�,z,� i <br />PLUMBING SIGN <br />�- <br />CITV ?IP PHONE <br />CITV Tip PNONE <br />�ITV ZI PIiONE STATELICENSEp <br />�-y'�+"w•�' n� ��a�37 7'i�"-.('`/yd' ,��.DE�c/ 93/�I Z <br />i�7/ Z�P PHONE STATELICENS[> <br />'�TV ZIP PHOflE STAiELICENSEx <br />�.,...v�� �i' ����7 �y� -r�ud' ,<K.�E�2c �9 3 M 2 <br />DEMOLITION � WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br />CONTACTFIAC/ /�,/J_N'{/p <br />S �� �� E� <br />�yS -sy�� �yz �3s-6 z <br />i HEREBY CERTIFY THAT I HAVE READ 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 PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV1310NS OF AN'! <br />OTHER STATE OR LOCAL LAW REGULATMG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PER�ORM THE WORK FOq WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOPS LAW 18.27 RCW AND 296.200 WAC. <br />'cr�aiix�E�� onrE / C_� <br />FEE NO. TYPE OF E�UIPMENT <br />O � A/C—AMNDLG UNITS—H.P. <br />; FORCED Alfi SYSTEMS—B.T.U. M E.A. <br />/D � UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WAT�R HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />5 ' HEATPUMP <br />� GAS PIPING <br />�; EXHAUST FAN <br />0 <br />SIOESETBACN PLANCMECKNUMBER FEE <br />�o5v <br />vacnNr sirE FEES <br />euaoiNc <br />occunquCv NOofPr:Ewi,Gu�:us <br />GH9VP <br />PLUM�MG <br />�15EIdENi <br />MECHANICAL <br />HEIGHTLifARAiION ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY QP EVERETT PUBLIC WCRKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL 3 <br />PEP,MIT $ <br />TOTAL FEE S <br />FECEIPT NO. <br />VALUATION FEE <br />� <br />i <br />__� <br />