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APRLICATIQ""i FOR CONSTRI,ICT^1N PERMIT � <br />/\` � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />,� <br />BUILDI(�G DEPAR-fMENT HEATING SYSTE��I: GAS ❑ ELECTRIC ❑ -� <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �UILDING ❑ MECHANI �AL ❑ PLUMBING ❑ SIGN <br />OWNEP MAILADORES� CITY 21F PHONE <br />�I7� i _ � _ � ,. �'___ �� �%...�G+n.,,Y CJN_ L.^ c� i fi�i„� 2�f7 _ �� � <br />ARCHITECT OR DESIGNER M/ <br />�'pn�.N�cL ]�src�J <br />PLUMBING CONTflACTOR <br />arn NTflACT PRICE OF WORK <br />2l �-i� .�.A�T <br />MAIL AODRESo <br />iTqGE INVOU'EO <br />L —_�`e,�f <br />� �, _ -� ,�= <br />� <br />i� t•tisc . <br />� ��/ G� <br />LEGAL DESLRIPTION OF PROPERN �SHOWN BELOW <br />LOT BLOCK OF <br />P4flCEL <br />LENDF.R, ADDRESS, iF.1.EFHUNE <br />PLUMBING <br />N0. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHO�YER <br />KITCHEN SINK 8 �ISP <br />D�SHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIIJS-RAINLEAC <br />SINK (SERVICF-BAR, ETC <br />CITV <br />:.�rr ,�u� u� <br />21P PHO E <br />'f,t�L <br />21P PHONE <br />PHONE <br />21P PHONE STAIELICENSEt. <br />ZIP PHONE :i31cLICENSE� <br />•GO/�fANDPHONSNG. K�G� <br />%�'/SrVF� C�C- ` � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ?HIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />nvocoaiesl 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 OP CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFJRMANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />' CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br />, X��aE , ` �� u eZ Z3 _ <br />SU3 TOTAL $ <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK FEARSETBACH <br />USE ZONE LOT AFEA <br />7VPE OF CONSi NO OF STOflIES <br />�� � <br />SRE OF BLOG. FIfiE SPRMKI.EA: <br />�. <br />REASON <br />INiFKE BV � ALANS APPROVED BV <br />D:.TE ' �/LJd. <br />FEE N0. TYPE OF EOUIPMENT <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 HEATEfi <br />� WOOD STOVE <br />� METAL FIREPLACE (WOOD BURNING) <br />; FIREPLACElNSERT <br />HEAT PUMP <br />; GAS PIPING <br />� EXHAUST FAN • <br />PL�N <br />VACANT SITE FEtS <br />❑ YES ❑ NO BUILO�NG <br />OCLOPANGV NO OfOWRU�iGIINItS <br />�"�.L° � PWMBING <br />O <br />BnSEMENT MECHANICAL <br />pO YES .�C NO <br />HEiGHTLIMI7n.7loN ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGC <br />CITY OF EVERETT Pueuc wa,Ks <br />LOCALSALES <br />TAX CODE IS 3105 rorn� <br />PERMIT $ <br />TOTALFEE $ <br />Fee� / � 3. � <br />� <br />�� � <br />