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v APPLICATIC�] FOR CONSTRUCT'�N P�RMIZ�i, <br />` `� TO BE COMPLETED IN BLACK INK—PLEASE PRIIJT F^�� <br />N <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS �] ELECTRIC ❑____ __ _� <br />259-8810 � � <br />❑ DEMOLITION ❑ COMBINATIDN ❑ BUILDING [k1NECHANICGL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDRESS CITV 21P P40NE <br />�F.Cl�c6,r.e Pixs 9� ss� �svr.�r.w� �.. •�. ,e-ar..�cstu.,r ���sa � <br />TENANT MAIL ADDRESS . CITV ���. y�� nqpNE � <br />Ci��r�ve�sn�.�w�r�•s�,fno. - 9oG Sa��r,�r.rss,a.r 9�'o1y �.✓7.t3r7 <br />ARCNITECTOROESIGNER MAILAD ESS QTl' ZIP PNONE <br />Tl'�.✓ r� /6•t*/9it/� .� L�rOwvouY� ui.p' S'8b�� f� �f/.3x� �l-�iF.S�� <br />GENERAL CONTPAGTOR MFIL AODPESS pTY ZIP PHONL STATE UCENSE R <br />u.v�✓�ns� ..��,�,�u� s.ci�.ie �.r,�c. /f�7,�r.a..�s��.�'a/��1�1 s9,r��,.av�yss.lr,G <br />MECHANICFLWNTRACTOR MAI�ADDRESS CITY ZIP PHONE STATEUCENSER <br />CONTRACTOR MAILADORE55 <br />CONTHACT PFILE OF WORK a <br />�C�• � <br />UESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />] <br />PROPOSEOUSEfO�FQBUyILD—ING �� � <br />LEGAL DESC� TION O� OPERTV �SNOWN BELON' Cd ATTACH TWO COPIES) <br />LOT BLOCK OF <br />�'�81St� /JS�l- <br />PARCELTAXI.D.NUMBEB <br />CONSTRUCTION LOAN LENDER, ADDRESS, <br />PROJECT ADDRESS <br />WATER CLOSET (TUILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SIIJK 8 DISP <br />DISHN/ASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />bRCKFLOW PREVENTERS <br />ROOF DRAINS—Ri.INLEADERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />USE ZONE <br />7VPE OF CONSi <br />SIZE OF BLOG. <br />OCCUPANCVL� <br />E�SON <br />�KE BY <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE S <br />OF STORIES <br />FIPE SPflINNLEFS flE�'D <br />FIRE FLPRM REO'D <br />onTe <br />0'. <br />0 <br />ZIP PHONE STATE <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOR�TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />S�GN IIB ��p�f/%� <br />Q,�% -r <br />GTY BUSIM1E55 LICENSE NO. <br />MECHANICAL <br />VO. TYPE OF E�UIPMENT FEE <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 />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � � <br />FIREPLACE IMSERT ; <br />HEAT PUMP <br />GAS PIPING ' <br />EXHAUSTFAN � <br />PIAN CHECK NUMBEB <br />4ACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OC[U>ANLV NO O�UWELlING11NIt5 <br />taour PLUMBING <br />BnSEMEN7 MECHANICAL <br />❑ YES ❑ NO <br />HEI3HTLIMRATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOPKS <br />LOCAL SALES <br />TAX CODE IS 3105 rora� <br />FEE <br />PERMIT $ <br />TOTALFEE $ <br />N0. <br />N <br />; <br />