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APPLICAT�C'�"1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PL�ASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ --� <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOL{TION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />O NEB MAILADDRESS CI ZIP�M� PHONE �, )�/� <br />�<c�hy ,�r /�s �av .SE �i %�%p/�%/✓ y' �-�• ��- <br />TENAN � MAILA��g� S CITY ZIP PMONE <br />/,��s,c � �no (/�Po�i � �� D�� <br />ARCHITECTORDESIGNEP AILADDRE55 CITY ZIP PHONE <br />GENEflALCONTflACTOft MAIIADDPESS CITV ZIP PHONE STATELICENSEN <br />MEC}� ICAL NTRACTOR MRILAD � �� / ��T� Z�P PHG`IE STATELICENSEM <br />�Il��eXJl����en ennaF . cirr cm ����.� �•...--'--"-- <br />WNTRACTPRIC OFWORK <br />DESCRIBE WORK AND SQUAflE FOOTAGE INVOLVED <br />OF <br />LEGAL DESCflIPTION OF PFOPERTV (SNOWN BELOW OR ATTACH TVJO COPIES) <br />LOT BLOCK OF <br />PARCELTA%I.O.NUMBEH <br />CONSTRUCTION LOAN LEI <br />NO. � TYPE OF FIXTURE <br />—� WATER CLOSET(TOILET) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFiEVEN' <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAF <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACN <br />115EZONE LOTAREA <br />TYPE OF CONST. NO.OF STORIES <br />SIZE OF BLDG. FIRE SPflINK�ERS REO'D <br />nrruoeucv i nen FIPE ALARM REO'D <br />REASON <br />INTANE BY <br />L'nTE <br />� <br />5 <br />CONTACT PE�i50N AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOP.K 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 OFi LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAN�E OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />AFPLICATION IS MADE A�dD 1 COMPLY WITH THE STATE <br />CONTflACTORS LAW 1827 RCW AND 296.200 WAC. <br />NO. TYPE OF E�UIPM <br />A/C—h�HNDLG UNITS—H.P. <br />FORCED .41R SYSTEMS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRl'ERS <br />VENTILATION FAAI <br />RANGEHQOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />VACANTSITE r«" <br />❑ YES ❑ NO BUILDING <br />OGCOPANLY NO.OfOYJFlUN6UtIRS <br />eeouc PLUMBING <br />BnSEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITATION AD�ITIONALPLANCHECK <br />OTHF.F <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 70TAL <br />M <br />SUB TOTAL 3 C/ ' ' <br />PERMIT $ � � <br />TOTAL FEE $ ' � <br />RECEIPT NO. <br />VALUATION FEE <br />i <br />i <br />i <br />i <br />i <br />-- i <br />i <br />