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APPLICATII`Y FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTPAENT HEATING SYS7EM: ❑ GAS ❑ ELECTRIC ❑ <br />25°-8810 <br />� EMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />COWNE lAAILA�ORESS CITV ZIP PHONE <br />Larry Hillis 62Q SE Everett Mall Wy Everett 98208 347-5010 <br />TENANT MAII ADDRE55 CITY 21P PIIONE <br />Arctic Windows 620 SE Everett Mall �day Everett 98208 568-?136 <br />ARCNITECTOFOESIGNER iAAILA�ORE55 <br />CITY <br />PHONE <br />��iriniwi�n miv�nwneoa cin ur PHONE STATELICENSEd l �/ <br />Arctic Windows 620 SE Everett Mall Wy Everett WA 98208 568-2136 —" <br />IAECHAIlICALWNTRPCTGR MFIlAODRESS GTV ZIP PHONE STATEUCENBEz <br />PLUMBINGCONTRFCTOR MAILpDOFF.55 <br />GONTRACT PRI OF WOFK <br />$6,000.00 <br />DESCRIBE WORK ANO SOUARE FOOTAGE INVOLVED <br />PROPOSED USE OF BUILDING <br />LOT <br />PROPERTS �SHOWN BEIOW OR ATT:.CM TWO COPIES� <br />eLOCN OF <br />`PARCEI TA%ID MBER <br />182-205-3-049-0000 <br />CONSTRUCTIONLOANLENDER,ADURESS,TEL[PHONENUMBEfl <br />ltIIICJJ <br />SE Everett Mall Way Everett 98208 <br />NO. � TYPE OF FIXTURE OR ITEM <br />—�WATER CLOSET (TOILETI <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />URINAL <br />FLOOR DflAIN \ <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—iiAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />SUB TOTAL S <br />PERMIT C <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />USE 20NE <br />NPE OG CONST. <br />�i <br />SIZE OF BLDG. <br />1�(o0�i.� T.f <br />OCCUPANCYLOAD <br />REASON <br />LOT AREA <br />I <br />FIRE SPRINKLERS REQ'D <br />No <br />FIFE FLAnR'M flE�'D <br />31/ U <br />CITY ZIP PHONE STATEiICENSEp <br />FEE <br />VACANT SITE <br />� YES ❑ NO <br />OCCOPi4LY NO Oi]WFILiNL� <br />❑ YES JG NO <br />HEIGNT LIA7ITATION <br />INiAKEBY PLANSAPPROVEDBY CITYOF <br />�M LOCAI <br />UAiE �/�//./A� TAX C0� <br />CONTACT P�N ANO PHONE N0. <br />S�(o <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIOIJS OF LAWS AND ORDINANCES GOVEFlNING 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 CAPlCEL THE PROVISIONS CF ANY <br />OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MhDE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAVy 1827 RCW AND 296.200 WAC. <br />MECHANICAL <br />N0. TYPE OF E�UIPMENT <br />NC—NHNDLC� UNITS—H.P. <br />FOHCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESORYERS <br />VENTILATIOtJ FAN <br />NGE HOOD <br />'d�AT2� HEATER <br />WOOG VE <br />MET: ��. FIREI�ACE (WOOD BURNING) <br />FIREFL4CE INSLT�T <br />HEAI PUMP <br />EXHAUSTFAN <br />NUTABER <br />�UILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTH�R <br />STATE BUILDING SURCHARGE <br />PUBLIC WOFKS -_ <br />TOTAL <br />SUB TO'iAL <br />PERMIT <br />TOTAL FEc <br />� <br />FEE � <br />,S� . (s:� <br />VA�UATION <br /><a,DOD `� <br />T <br />T— <br />SI � <br />c�c� <br />