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� APPL�C14T1('"`I FOR CO�ISTRUC7'`�iN PERMIT �� <br />��\ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �UILDING !7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL <br />�� <br />ORDESIGNER MAILAODRESS <br />� <br />MECHANICAL <br />PLUMBING C( <br />MAII ADDRESS <br />MAIL ADDRE55 <br />WNTBACT Pi110E QF�EIORK <br />LJ <br />7, SOO'z= <br />OESCRIBE WORK FND SOUARE FOOTAGE INVOLVED <br />1����I �� �� 7 <br />—� <br />��� � �r��� <br />PROPOSED USE OF BUIL�DING <br />/��5�� �rix�l <br />LEGAI DESCFIPTION OF PROPERN <br />�pT,�-- OLOCK � <br />BELOW OR ATTACH TWO WPIES� <br />— OF <br />PARCEL TAX D. �M�R � � C � � — ^n � ' <br />., <br />TYPE OF FIXTI <br />WATER CLOSET (TOIL� <br />BATHTUB <br />LAVATORY(WASH BA'. <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />:�� <br />ITEM <br />CITV �J/�ZIP <br />IF QF�IT I D C <br />CITV Z�P <br />cirr z�a <br />PHONE <br />PHONE <br />CIN ZIP rnvno <br />°��RFir �f;x� I r5`i'-2� <br />CITV ZIP PHONE <br />CITV 21P PHONE <br />CONTACiPERSO�ANOPH E.'iQ.,,2 <br />� � jj J <br />l � 1►'1 ef�Y /��vkual <br />STATE LICENSE a <br />P�.�t eac� � <br />STATE'ICENSEa <br />STATE LICENSE N <br />� <br />I HEREBY E THAT I HAVE READ AND EXAMINED THIS <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TYPE OF <br />WORK WILL BE COMPI.ETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 7HE GFANTING OF A PEP.MIT DOES NOT PRESUME TO GIVE <br />AUTHORITY 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 COMPIY ViITH THE STATE <br />CONTflACTORS LAW 1827 RCW AND 296.200 WAC. <br />x� ��a�/l�� �/>9�9�— <br />SIGNNNPE AiE � <br />CITV OUSMESS LiCENSE 110 <br />MECHANICAL <br />N0. TYPE OF E�UIPMENT FEE <br />AIC-A/HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. h1 E.A. ' <br />UNIT HEATEi;S-B.T.U. M � <br />CLOTHES DHYERS ' <br />VENTILATION FAN _ � <br />WATER HEATER <br />WOOD STOVE ' <br />METAI FIREPLAC[ (WOOD BURNING) ' <br />FIREPLACE INSERT � <br />HEAT PUMP ' <br />GAS PIPING � <br />EXHAUSTFAN ' <br />"� SUB TOTAL 5 � <br />--� PERMIT 5 ! <br />TOTALFEE 5 ' I I -- <br />FOR OFFICE USE ONLY: �.�.�h ,CILfCi� u��� �� P� � <br />FRONT SETBA�K REAR SETBACK SIDE SETq0.CK AN CHECI . MBEH <br />r <br />� -,� r% .-i`/- <br />yp�ANT SITE � FEES <br />USE ZO LOT APEA <br />'7 �7_ ❑ YES � NO BUILDING <br />ttPEOfCONSi. NO. FSTORIES OcmrnNtv No.aoWfwxGUNrtS <br />aouv pWMBING <br />i�-3 <br />SRE OF BLOG. FIRE SPRINNLERS REO'� AASE� NT MECHANICAL <br />b II�YES ❑ NO <br />� i�_ SE 85�+u7 ADDITIONAL PLAN CHECK <br />OCLUPANGVLOAD FIREALARMREO'D HEIGN�MIT�ON <br />�� OTHER <br />REA:AN STATE BUILDING Sl1RCHARGE <br />INTAKEBY PLANSAPP[iOV€OBY CITY QF EVERETT PUBLIC WOFiKS <br />`���� TAX CODE S 3105 TOTAL <br />DATE '% /%�I/� � <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />� <br />,. <br />