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APPLICATIC�I FOR CONSTRUCT )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />uUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ _ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL <br />OWNER MFILADDFESS CITV ZIP P.1 <br />� <br />TENANT MqILA00RE55 QTV :IP , PHONE <br />f�,YT�C wWPawS G5o St EVfP.c7riHAri wY Fv�i�t�rr <br />AHCHITECTORDESIGNER MAILAODflESS CIiV ZIP PHONE <br />GENERALLONTqACTOR MMLAOURE55 <br />❑ PLUMBING ❑ SIGN <br />-�� � <br />CITY ZIP PHONE STATELICENSEa <br />MECHNNICALCONTRPCTOR MAILAODRESS CITV ZIP PHONE STATELICENSEa <br />ik1ET/�1S1N1 rFIS 7//(n-.22U��`StIJ 1bi�T �%$O�f3 3/e2•3H3U INE7pLI * ly/c yr. <br />FLUMBINGCONTRACTOR MAILADDRE55 CITY 21P PHONE STATELICENSEa <br />e e <br />.�O O � <br />AND SOUARE FO( <br />w <br />�a <br />PRO.°OSED USE OF BILLDING <br />��rA/G <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW Ofl ATiACN TWO COPIES) <br />lOT BLOCK OF <br />PAFCEL7A%I.D.NOMBER <br />CONSTRUCTION LOAN LENDEP, AOORE55. TELEPHONE NUMBEfl <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />KITCHEN SINK & DISP <br />DISHWASHER <br />CLOTHES WASHER <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRA!N;,�—RAINLEAC <br />SINK (SERVICE—BAR. ETC <br />� <br />SUB TOTAL 5 <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FflONTSETeACK REARSETBACK <br />USEZONE LOTAREA <br />TYPEOFGON57. NO.OFSTORIES <br />SiZE OF B�DG. FlRE SPRINHLEflS REOD <br />INTAKE BV <br />LOAD � FIREALARMREO'D <br />OATE <br />N0. <br />.� <br />I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND 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 GRANTII�G OF A PERMIT DOES NOT PRE�UME TO GIVE <br />AUTHORITY TO VIOLATE OR CAtdCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING GONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I ADE ANG I COMPLY WITH THE STATE <br />CONTRACT LAW 1.2LRCW AND 296.200 WAC. <br />crtrouswEssucervsEr�o. <br />MECHANICAL <br />FEE <br />SI�E SETBACK � PLFN <br />VACANT SITE <br />❑ YES ❑ NO <br />acuvnHcr xo.ovoweuixcuxrts <br />GFOOP <br />BASEMENT <br />❑ YES ❑ NO <br />HEIuM� LIIdITATION <br />�ITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />A/C—A/HNDLG UNITS—H.P. 3 <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M��,p�p,a7 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATCR <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUST FAN <br />BUILDING <br />PLUtABING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />FEE <br />PERMIT $ /.S � ' <br />TOTAL FEE 5 /OL ! � <br />a <br />� <br />R <br />i <br />