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APPLICATIC`1 FOR CONSTRUCT'"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � <br />259-8810 <br />i� DEMOLITIUN I I COMBINATION <br />OWNEnR^ AIA1lADDRE55 <br />TErvnNT �A V'—�_� M^t� i`TS G� lr <br />/110 �V � <br />ARCMITECTORDESIGNER MAILAD�RFSS <br />MAIL <br />c��u h�� <br />CONTRAGT PRICE CF WORK <br />DESCRIBE WORK AND SOIIARE FOOiAGE INVOLVED <br />HEATING SYSTEM: ❑ GAS iJ ELECTRIC ❑ <br />i i BUILDING <br />CITY <br />l ��5� <br />citr <br />PROPOSED USE OF BUILUING <br />� � � <br />IEGAL DESCRIPTION OF PPOPERTV �SHOWN BELOW OR ATfACN TWO COPIEL� <br />Lor BLOLK — oF <br />P4PGELTA%I.D.NUMBEfl <br />�Qn7 /=C�Si- <br />CONSTR CTIONLOANIENDER.A0UFE55.TELEPHONENUMB� ER <br />PLUMBING <br />p, TYPE OF FIXT <br />3 WATER CLOSET(TOII <br />BATHTUB <br />LAVATORY (WASH BA <br />SHOWER <br />, KITCHEN SINK 8 DISF <br />�' DISHWASHER <br />LAUNORYTRAY <br />�/ (;LOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLON'PREVEN' <br />ROOF DRAINS--RAID <br />1 SINK (SERVICE—BAF <br />OR ITEM <br />❑ MECHANICAL �%C PLUMBING ❑ SIGN <br />Z� �,� r�4- aa�o � �4� 164 � <br />Z�y PHONE <br />��,� Z�� <br />GI7V ZIP <br />dTV ZIP <br />CITv 21P <br />FEE <br />� <br />PHONt ain�tUbtnoc� <br />PHONE STATE LICENSE � <br />PHONE STATE LICENSE � <br />CONTACT PERSON AND PMONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EKAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AN� 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 />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI �ON OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNcR 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 296200 WAC. <br />.. •�i:.� l.i 1/,%�� O7 26 �f� <br />TVPE OF EQUIPMENT <br />AIC—AMNDLV VNITS—H.P. <br />FORCED AIR SY:�TEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRY[RS <br />VENTILATiON FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WJOD BURNING) <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EaHAUSTFAN <br />� „UB TOTAL $ <br />PFRMIT $ ' — <br />�— � TOTAL FEE $ � ' I <br />FOR OFFI�E USE ONLY: <br />FRONiSETBl.CK REAq5ET8pCN SIOESETUACN PL�NCNEGI N^UMcBEfi FEE <br />��(�! _J <br />USEZONE LOTARE� VACANTSITE FEES <br />n ves n No BUILUMG <br />iVPE OF CO45T. NO. OF STORIES auursNcr x0 of OwLlixcuMiiS <br />cnouv pWM81NG <br />SRE OF tlLOG. FlRF SPRINKLERS REO'D BASEMENT MECHANICAL <br />FEASON <br />❑ YES ❑ NO <br />FIR[ ALARM flE0'D HEIGHT uMrtATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PLANSAPPROVEO�V CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />DATE TAX CODE IS 3105 roTn� <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />RLCEIPT N0. <br />0 <br />�x <br />n <br />� <br />�p <br />N <br />�N <br />n <br />