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APPLICATIQ� 1 FOR CONSTRIlCT'"1N PERMfY � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYoTEM: I� GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT '— <br />259-8810 <br />�l DEMOLITION ❑ COMBINATION <br />OWNER A/y� �OD/pESS <br />/ n. .n� A � / �J .� �/ � `< <br />JANj /� - <br />! n i . / / <br />❑ BUILDING <br />qTV <br />❑ MECHANICAL <br />21P PHONE <br />ZIP <br />PLUMBING ❑ SIGN <br />ARCMITEGTORDE". NEH IAAILA�O�iESS � CITV nP rn��� <br />��n. Z�p PHONE STATE LICENSE tl <br />GEhERALCONTRACiOF �.�A'��ADDBESS <br />MECHANICALCONTRACiOH h1AILADDRESS CRY ZIP PNONE SIDTELIGENSEa <br />3�°r�LW <br />CONTRACTPRICEOF-40RK � <br />OESCRIBE WOPK qN0 SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LEGAL �ESCFIPTION OF PROPERN (SHOWN BEI OW Ofl ATfACN TWO COPIES) <br />LOT BLOCK OF <br />PARCELTA%I.D.NUMBEH <br />CONSTRl1CTION LOAN LENDER, ADDflESS. <br />TYPE OF FIXTI <br />WATER CLOSET�TOIL <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISH6VASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SEFVICE—EAR, ETC <br />FOR OFFICI= USE ONLY: <br />FRD�lTSETBACK PEARSETBACK <br />IISE ZON� �OT AREA <br />1fPE0FCONSi. <br />SIZE OF 9LDG. <br />OGGUPANCYLGF� <br />R[ASON <br />RlL1'de GV <br />OF <br />ITEM <br />SUB T( <br />PERMI <br />TOTAL <br />FIRE SFRiVKLEflS AEO'D <br />I";RE ALARM RE�'D <br />DATE <br />APPROVcDBY <br />� <br />CONTACT PERSCN AtJ� PHONE NO. <br />� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNJW THE SAME TO BE TRUE AMD CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIIJG 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 PROVISIONS OF ANY <br />OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF COPISTRUCTION.'i HAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROP�RTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CU�dPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />� ( ^' �i �----�� o,.E <br />SiGNA1MF _ <br />FEE N0. TYPE OF EOUiPMeni <br />, A/C—NHNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT IIEATERS—B.T.U. M <br />GLOTHES DRYERS <br />VE�TILATION FAN <br />RANGEfi00D <br />WATER HEATER _ <br />, WOODSTOVE <br />FIREPLACE INSERT <br />HEAT PUMP � <br />GhS PIPING � <br />FXHAUSTFAN , _ ' <br />SI�ESETBFCK r�nrv...+�...�..��..�� /.�� / I <br />� <br />VACANT SITE FEES � <br />❑ YES �-1 NO gUILDiNG <br />OGpIPAMLY LO O�WJILC.':GII'.IiS <br />�P0°" PLUM6ING <br />ansE!derdr 1AFCHANICAL <br />❑ YES 7 NO — <br />HEi�NT�m�iTAnoN ADDITIONALPLANCHEG( <br />OTHEF <br />STATE OUIi.01NG Sl1flCHARGE <br />CITY OF EVERETT ausuc.voaKs <br />LOCAL SALES <br />TAX C60E IS 3105 TOTAL <br />0 <br />SUB TOTAL S __�j_ <br />PERMIT S <br />• <br />