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APPLICATIO`` FOR CONSTRUICTI"`N PEI�MIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �r <br />BUlLDING DEPARTMENT HEATING SYSTEIA: ❑ GAS f_] ELECTRIC �j �/p(i � <br />259-8810 <br />L7 DEMpLITION ❑ COMBINATION <br />OWNER MAILADDRESS <br />GENERAL <br />CONTRACT PRICE OF WORK <br />IAAIL <br />MqIL <br />� <br />MAI� <br />❑ BUILDING <br />CITY <br />"�G.��C <br />Ciiv <br />VFR E7T- <br />CITY <br />LEGAL DESCPIPTIpN OF PROPERTV �SHOWN BELOW OR ATTACH TWO COPIES) <br />�or BLOCN or <br />PARCELTAXI.O.NOMBER <br />�&�R ^ U�3_ <br />CONSiRUCTIONLORNLEN�ER.AD�RE55.TELEPI <br />TYPE OF FIXT <br />WATER CLOSET(TOIL <br />BATHTUB <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />ROOF DRAINS—RAINL <br />SINK fSERVICE—BAR. <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARoETBACK <br />USE20NE LOTAREA <br />7YPE OF CONST NO. OF STORIE'. <br />OR IiEM <br />.Y�' <br />FEE <br />MECHANtCAL <br />ZIP <br />ZIP <br />❑ PLUMBING <br />STATE <br />f J SIGN <br />i HEREBY CERTIFY 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 GOVEFNING THIS TYPE O� <br />WORK WILL BE COMPLETE� WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUPAE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATW� CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />ci,vousirvEssiicEhsEh� - --�—"'�— <br />MECHANICAL <br />NO. 7YPE OF E�UIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEF <br />WOOUSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXIIAUST FAN <br />SUB TOTAL $ � ; SUB TOTAL <br />PERMIT $ I PERMI7 <br />TOTAL FEE g � rnrni FFF <br />SIDESETBACK PLANCHE KNUh7BER FEE <br />533/ <br />VACANi51TE FEES VALUATION <br />i.7 YES ❑ NO BUILDING <br />acuanr:cr no arowcuwcuvus <br />ceoua <br />PLUMBING <br />SRE OF BLGG. FIRE SPRINKLERS REOD BASEMENT <br />MECHANICAL <br />I i YES ��_ NO <br />OCCUPANCY LOFU FIRE ALARId REOD HEIGMT LIMITATIpN ADDITIOI�AL PLAN CHECK <br />INTPKE BY <br />DATE <br />OTHER <br />STA7E BUILDING SURCHARGE <br />'B`" CITY OF EVERETT pUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />� <br />0 <br />/�- � <br />i�= , — <br />NO <br />F <br />