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� <br />APPLICATIC^1 FOR CONSTRUCT'"lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRfNT <br />BUILDING DEPANTMENT HEATING SYSTEM: U GAS ❑ ELECTRIC J <br />259-8810 <br />❑ DEMOLITION _ ❑ COMBINAI'ION f 1 BUILDING �1�ECHANICAL ❑ PLUMBING ❑ SIGN <br />� <br />GENERALCONTRACTOR <br />ME�HANICAL CONTRACTOR <br />MAI� ADDRE55 <br />A.ff� <br />IdAIL AD�RESS <br />M�IL POORESS <br />CONTRACT PRICE OF WORK fA �O�O <br />Q�Ey <br />'���� <br />UESCRIBE WORK AND SQUARE F TpGE INVOIYED <br />IN`�i� l�l�i✓ : 11�N '7 �/� <br />PPOPOSEO USE OF/BUILDING <br />IEGAL DESCRIPTION OF PROPERTV �SHOWN BELONJ OR ARACH NJO COPIES� <br />LOT— BLOCN OF <br />FARCEI.TAXID.NUMBER <br />CONSTRUCTION LOAN LENDER. AD�RE55. TELEPHONE NUMBER <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />�ATHTUB <br />LA�'ATOP,Y (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLCTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEIJTERS <br />ROOF DRAINS--RAINI.EADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SEiB�CK FEAR SETBALK <br />USE20NE LOTAREA <br />iVPE GF CONST. NO. OF STOPoES <br />SI£e OF BLDG. FiqE SPRINKLEFS REO'D <br />OCCUPFNCYLOAO FIqEALARIAREO'D <br />INTAKE BV PL�NS APPROVED 9Y <br />�are <br />CITV IP <br />W � <br />CITV ZIP <br />��•� <br />GIiY Zlp <br />CITV ��o <br />CIiV ZIP <br />�:T�iT �� <br />CITV ZIP <br />FEE <br />0 <br />PHON^ <br />PHONE <br />PNONE <br />PHONE <br />�'�L[ <br />PHONE <br />CONTACT PERSON AND PMONE NO. <br />�� 3���" � -JTn <br />STATE LICENSE • <br />STATE LICENSE A <br />'c�Fl��i—�r�� ��fi.� <br />srere,u eNsl�O.MG'�/rWt� <br />�v/ <br />i HEREBY CENTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPI_ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAf ICES GOVERNING THIS TYPE OF <br />WORK WILL BE COMFLETED WiTH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAIJTING OF A PERMIT DOES IJOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL 7HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 6Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC,PpRS LAW 78.27 RCW AND 296.200 WAC. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT <br />PJC—A/HNDLG UNITS—H.P. <br />FORCED �11R SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />�LOTHES DRYERS <br />VENTII.ATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BI�Ri <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESE7��CK PL�NCHECNNl16�R I FEE <br />v <br />VACFNT SITE FEES <br />, , YtS � i NO BUILDING <br />OWOnpqp NOOipWELL�NGlllllfl - <br />�P00P PLUMBING <br />BnsEMENr MECHANICAI. <br />❑ YES ❑ NO — — <br />HFIGHTLIMI7ATION ADDITIONAL PLAN CHECK <br />OTNF.R <br />STATE BUILDING SURCHAPGE � <br />CITY OF EVERETT PUBLIC INORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT 5 <br />TO'AL FEE $ <br />FEE <br />� <br />_.�_ <br />� <br />8y <br />9 <br />