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APNLICATI�''V �OR CONSTRUCT�'ON PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL L�'PLUMBING ❑ SIGN <br />MAIL ADORESS <br />GENEflALCONTRACTOR MAILAOORESS <br />CITV Z�P <br />ZIP <br />PHONE <br />lAECHANICALCONTRACTOP MAILAODRE55 CITV ZIP PHONE STATELICENSEC <br />PLUMBING CONTPACTOR IANL ADDRESS CITY 21P PHONE STATE UCENSE N <br />% ,p/- 5 .4�"E G / y2o E ''� 3Ecc-�vu � � � � � <br />CONTRACT PRICE OF WORN <br />DESCRIBE WORK AND SQUAPE FOOiAGE INVOLVED CONTAGT PERSON AND PHONE N0. <br />PROPOSED USE OF BUILDING <br />l EGAL OESCRIPTION OF PROPERTV (SMOWN BELOW �R ATTACM TWO COPIES) <br />ior e�ocK oF <br />PARCELTAXI.D.NUM9ER <br />CONSTRUCTION LOAN LENDEF. ADDflE55, <br />N0. TYPE OF FI) <br />WATER CLOSET (TC <br />BATHTUB <br />IAVATORY (WASH 8 <br />SHOWER <br />KITCHEN SINK & DI: <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW PF <br />� <br />NUTA9ER <br />OR ITEM <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE 11SE ONLY: <br />fRONTSETBACK REARSET�ACH <br />U<_E201lE IOTAFEA <br />1VPEOFCONSi. NOAFSTORIES <br />SiZ[OfBLDG. FIRESPRINNLERSREO'U <br />REASON <br />DATE <br />SI�E SETBACK <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECl. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E 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 P'v1 AUTHOR2E� BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE VJORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />.. f�.L�.�-. (/ • <br />�/P• :J <br />SIG AiME DAIE <br />FEE NO. TYPE OF E�UIPMENT <br />� A/C—AIHNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />; UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />' VENTILATION FAN <br />� RANGEHOOD <br />� WATER HEATER <br />, WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />; FIREPLACE INSERT <br />HEAT PUMP <br />; GAS PIPING <br />� EXIiAUST FAN <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />PLANGMeCKNU1.I�ER FEE I RECEIPTNO. <br />VACANT SITE rcco <br />❑ YES ❑ NO BUILDING <br />aavzxcr noovmruu+cunrts <br />cnouv PLUMBING <br />BASEMEHr MECHANICAL <br />❑ YES ❑ NO <br />MEIGHT LndITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCA�SALES <br />TAX CODE IS 3105 TOTAL <br />YX <br />E <br />� <br />i <br />