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APPLICATIO : FOR COI�ISTRUCT� �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SY T • f <br />BUILDING DEPARTMENT S EM. .] GAS ❑ ELECTRIC fJ —� <br />259-8910 <br />LJ DENiOLE710N f"I COMBINATION Cl BUILDING <br />ov�wea — �,�na nooaess cin <br />��l✓ '+��''��-,a� Sr ST RE2KLE�1 �A <br />TEYM1flT _ M�ILAD�RESS �- <br />nnci{necr on oesicNen <br />GENERALC06TRI1CTOi1 MAILAD�RE55 <br />CONLRPCIOR MMLADDqESS <br />INTMCTOR MNLADOREES <br />CONTRACT PPICE OF WOflK <br />3opo � <br />�ESCRIBE WOBH AND SOU�RE FOOTAGE INVOW ED <br />..iNSTAGZ / Crr nc �Ji, <br />rnorosEo use aK ovaoiNc <br />�E Wl O[SCRIPtION OF PfiOPERTY (SNOWN BELOW OR ATTACH T WO COPIES� <br />LOi �LOCN pF <br />PMGEL TAX I D. NU�ABER <br />CONSTRUCTIONLOANLENDER. <br />NO. TYPE OF FIXTURE OR I'fEM <br />WATER CLOSET (TOILET) <br />BATHTUf3 <br />LAVATORY (W�SH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISFI^lASHER <br />� LAUNDRY TRAY <br />CLOTHES WASHEIi <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROO� DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSB78ACK <br />USE20NF C6TAIiEA <br />C-� <br />irrE or corisi. <br />SIZE OF BL�G. <br />OCIXIPANCY LO�D <br />(iEA50N <br />irirnKe ov � <br />SUB TOTAL $ <br />PERMIT $ <br />FIRE SPNIJKLERS REO'D <br />FIRE ALARM fiEOD <br />nim�s nn�noveo ov <br />onre J5(./�:LJ� <br />CITY <br />y �� <br />CITV <br />FEE <br />f 1 MECHANICAL CI PLUMBING <br />ZIP PI{ONE <br />-17/O � /Q/R <br />� {. �/j/ <br />ZIP <br />PNONE <br />353-�'LL <br />ZIP PHONE STAiE LIGENSE tl <br />S 355-���y SMp�r�'Ao73 <br />ZIP PHONE STATE LICEHSE p <br />21P PHONE SiATELIGENSEu <br />WNTACiPERSONANDPHONENO. ��SS SvA RON �- <br />55-OS`t�/ <br />I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br />APPLICATION ANU KNOW THE SAME TO�BE TRUE AND CORRECi. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOFK WILL BE COMPLETED WITH WHETHER SPECiFIED HEREIN OR <br />NOT. THE GRANTING OF 11 PERMIT DOES MOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OiNER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFl THE <br />PERFORI�IANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TFIE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296.200 WAC. <br />x.,� ,d�� S_�/ -95! <br />sir.r�ntm�[ nn�e <br />crv ousiness urmm rio — <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C—A/HNDLG UNITS—Fi.P. <br />FORCED AIR SYSTEMS—B.iU. M EA. <br />UNIT HEATERS—B.T.U. M ; <br />CIOTHESDRYERS T— <br />VENTILATION FAN <br />HANGEI100D <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) �— <br />FIREPLACF INSERT ' <br />HEAT PUMP <br />GAS PIPING <br />EXNAUST FAN , <br />SUB TOTAL $ <br />PEflMIT $ <br />TOTAL FEE 5 <br />SI�ESETBACK PLANCHECKNU 9E FEE <br />�y� �,�� 3s � v <br />VAC�NTSITE FEES VALUATI <br />f I YES ❑ NO OUILDINO �GEJ( <br />accurnucr xoovnxtuixeuxirs — <br />cnour pLUMBING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIh11TATION �ODITIONALPLANCH[CK <br />� �� OTHER <br />STATF BUILDING SURCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX CO�E IS 3705 rora� <br />nEceiPr ho. <br />i <br />� <br />� <br />� <br />