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APPLICATIO" F6R CONSTRUCT� �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PFiINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ ELECTRIC CI � <br />259-6810 <br />❑ DEMOUTION ❑ COMBINATION C BUILDING ❑ MECHANICAL X PLUMBING I 1 SIGN <br />OWNER IdA1V�00RE5S . GTY 21P PHONE � <br />�l2?/C /,�J�.�i�»uJ �2D �"��so�/ /%%q�L <br />TLNANT MAILADDFESS CITV 21P PHONE <br />�.GUllt�� ��D_�e� �'�-� .� o/ _% — <br />ARCHRECT OR DESIGNE <br />GENERAL WNTRFCTOR <br />fdNL AD�RE55 <br />MAIL ADORE55 <br />'LUMBINGCONTRACTOR M ADDRE55 <br />�FG6r��E <�m�i <br />CONTR�CT PRICE OF WORK <br />DESCPIBE WOPK ANO SOUARE i00TAGE INVOLVED <br />PROPOSED USE OF BIIILDING <br />L?G�L CESCRIPTION OF PROPERTV (SNOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OP <br />PARCELTAXI.D.NIIMBER <br />CONSTRUCTIONLOANLENDER.AOORESS. <br />PLUMBING <br />'�0. TYPE OF <br />� WATER CLOSET � <br />BATHTUB <br />LAVATORY(WASI <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />NUMBER <br />G G✓g <br />OR ITEM <br />� <br />SU6 TOTAL 5 <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONVf: <br />FRONTSETBACK Rl.ARSEiBACY. <br />❑SEZONE LOTAREA <br />TYPEOFCONST. NO.OFSTORIES <br />SIZEOFBLOG. FIRESPFINKLERSREO'P <br />OCCUPANCY LOAD FIRE ALARM REO'� <br />INiANE BV PLANS APPROVED BY <br />DATE <br />ciTv <br />CITV <br />pTV <br />cin <br />ZIP <br />ZIP <br />21P <br />ZIP <br />tie <br />PHONE <br />PHONE <br />CONTACT PERSON AND PHUNE NO. <br />STPTE LICENSE n <br />S7ATE LICENSE p <br />STRTE LICE(NSE a <br />FGn�P #�o <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIhED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORIiE(;T. ALL <br />PRCVISIONS OF LAWS AND ORDINANCES GOVERNING THiS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEH SPEC!FIED H�f1EIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PREiUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEfl STATE OR LOCAL LAW REGULATING CONS'fRUCTION OA THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICNTION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 295.200 WAC. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SI�ESETBACK PLANCHEC<NUM6EF FEE <br />��'��7 � <br />VACANT SITE FEES <br />J YES ❑ NO BUILDING <br />acuva,a xaarorieun:smurs <br />�POpP PLUMBING <br />9ASEMENT MECHANICAL <br />❑ YES t'-7. NO <br />HEIGHTLIMITATION A�DITIONAL PLAN CHECK <br />OTHER <br />STATE BUIL�ING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES — <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />3 <br />� <br />