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■ <br />�-�� �,.2� APPLICATIC" 1 FOR CONSTRUCT'1N PERMIT <br />i e ���fj` TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />lJ" / <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑_ <br />259-8810 <br />❑ DEMOLITI ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER �� M4ILADDRE55 qTV ZIP PNONE <br />� -r�r� �02� �o��=� 5,- c�c�� 3y�-loG- 1 <br />TENANT MqILADORESS CIN ZIP PHONE <br />ARCMITECT OR DESIGNEF MAIL ADDRESS GITV ZIP PMONE <br />AUT�-��=Nic c�wtvid}� 7S� 5 i zSc�`t'` Cc�v i� I(e ; I�J A`� a?3q <br />GENERALWNTRRCTOR MAILADDRESS CIiV ZIP PHONE STRTELICENSE� <br />o�t�-ST�� i> u� sN��v �T t3w1L mtiaPYs�Ic�E 9'8z7o o���ssp�bccw� <br />MECHANIGFL CONTRACTOR MAIL ADJRESS CITV ZIP PHONE STATE LICENSE t <br />PLUMBING CONTRACTOR MAIL ADDRESS CIN 21P PHONE STATE LICENSE I <br />CONTRACT PflICE OF WORK <br />DESCRIBE WORK AND SOl1ARE FOOTAGE INVOLVED <br />j�,lJ I I Yl L� l� f-1 C��lu c.z. <br />� / — <br />PROPOSED USE OF BUILDING <br />IEGAL DESCRIPTION OF PROPERTV �SHOVJN BELOW OF ATTpCH TWO COPIES) <br />LOT BIOCN OF <br />PARCELTA%I.D.NUMBER <br />CONSTRUCTIONLOANLENDER. <br />TYPE OF FIXTURE OR f <br />WATEa CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />D�SHWASHER <br />LALINDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOF DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK NEAR: <br />USE ZONE <br />IYPE Of CONST. <br />SIZE Of �LDG. <br />REASON <br />SUB TOTAL � <br />PERMIT $ <br />TOTAL FEE $ <br />NO. OF STORIES <br />FIRE SPPINKLERS REO'0 <br />FIRE ALARM REOD <br />DATE <br />APPROVED OV <br />FEE <br />0 <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ A'�D E7(AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECT. ALL <br />PROVI�IONS 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 PflESUME TO GIVE <br />AUTHORITY TU VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEC BY THE <br />OWNER OF THIS PROPERTY TO PEFFOR�d THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW At�16296.200 WAC. <br />MECHANICAL <br />10. TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.TU. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />META� FIREPLACE (WOOD BU9NING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />. GAS PIPING <br />SIDESET'JACN PLANCHEq� MBER FEE <br />G< <br />vncnNr site FEES <br />❑ VES ❑ NO BUI�DING <br />O[LUM.NGv NO Of �WFIUNG UNIiS <br />enouv p�UMBING ' <br />BnSEMENT MECHANICAL <br />❑ YES ❑ NO — <br />HEIGHTLIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />PECEIPT NO. <br />� <br />N <br />