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APPLICAi1C'1 FOR CONSTRUCT" )N PERMIT <br />TC� BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />RUILDING DEPARTMENT <br />209-8810 � <br />Ci DEMOLITION �i1 COMBINATIOM <br />OWNER MAI� A�DRE55 <br />PLUUBING <br />CONTRACT PRICE OF WOflK <br />�Cl D °: <br />]ESCRIBE WOPK ANq SOUARE <br />MAIL A�OPESS <br />�uC :__ <br />MAIL AUDflESS <br />�•S"Tt1.V< <br />MAIL AOOflESS <br />rClvrz� <br />MAIL ADORESS <br />MAI: A�ORESS <br />7AGE INVOLVEO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />❑ BUILDING <br />CITY <br />� <br />CITY <br />ty7"/11L1. i <br />CITV <br />CITY <br />� lTyav�. <br />CITY <br />CITV <br />PROPOSED USE OF BUILDING <br />�P. L.STAU(inNT <br />�EGAL DESCRIPTION OF PROPeRI V(SHOWN BELOW OR ATTACH TVJO COPIES) <br />LOT BLOCK OF <br />PARLELiA%I.D.NUMBER <br />CONSTRUCTIONLOFNLENDER,ADDRE55. <br />TYPE OF FIXTURE OR ITEM <br />WATEF CLOSET (TOILET) <br />BATHTUB <br />L4VATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISliWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRl�IN <br />BACI(FLOW PREVENTERS <br />SINK <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE US� ONLY: <br />FRONTSETBACK REARSETBACN <br />USE?ONE <br />TYPEOfCONST. NO.OFSiORtES <br />/ <br />SIZE OF BLDG. FIPE SPflINKLEFS REO'D <br />fti�GN4�tYAG TI. uo <br />OCCUPANCV LOAD FIRE 4L�RM REQ'D <br />A1U G�Ul�IE 7. i. �u <br />INTAKEBV I LATESiPP'%V'F��Y <br />�u:; <br />❑ MECHANiCAL <br />Z�P // PHONE <br />U��O\ �S <br />Z�P PHONE <br />3�� <br />Z�P PHONE <br />❑ PLUMBING ❑ SIGN <br />>.w. C-OMonos 143-yXZ OCH� <br />Z�P PHONE STATELICEN°Ex <br />� <br />I�P PHONE STqTE LICENSE a <br />CONTACT P'_RSON AND PHONE NO. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE A'JD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEfiNINC THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SFECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOl' PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRUVIS:JNS OF ANY <br />OTHER STATE 09 LOCAL LAW REGULATING CONSTRUC'ION OR THE <br />PERFORNANCE OF CONSTflUCTION. THAT I AM AUTHORIZED BY �fHE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPL:' WITH THE STATE <br />ONTRACTORS LAW 7827 R W AND 296.20 4VAC. <br />( i <br />�5 � ld-9-ti3 <br />N0. TYPE OF E�UIPMENT <br />A/C—A/HNDLG UNITS--H.P. <br />FORCED AIR SYSTENIS—B.T.U. A�1 <br />UNIT HEATE�IS—B.T.U. M <br />.I.OTHES D�YERS <br />VENTILaTION FAN <br />RANGEHUOD <br />WATER HEATER <br />bV00D STOVE <br />METAL FIREP�ACE (WUOD BURNIN6 <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OCCIIVANCY Hp OiUWFLLINGUNIIS <br />�Au3 �' pLUMBING <br />BnSEMENT MECHANICAL <br />❑ YES �Z'i NO <br />HEIGMTLIMITATION A�DITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT pUBLIC WORF:S <br />LOCALSALES - <br />TAX CODE IS 3105 TOTAL <br />PERMIT <br />TOTAL FEE <br />�� <br />S <br />H <br />. . . �?r:�:?i <br />