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APPLlCATIC- � FOR CONSTRUCT�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: 'iJ GAS .J ELECTRIC U � <br />BUILDING DEPARTMENT <br />259-8810 � <br />I DEMOUTION !� COMBINATION ✓ BUILD�NG MECHANICAL PLUMBING !! SIGN <br />nwuGv MAILADCRE55 . _ CITY ZIP PHONE <br />Sc.w� t, c. <br />pRCHITECT OR �ES�GNEF <br />MAIL ApORESS <br />o,loo VQi <br />IAAIy ADDRE55 <br />'J�I OtJ <br />%' �V� � ' ' t1���.J <br />GTV ZIP PNONE <br />GITY ZIP PHONE <br />GENERALCONTRACTOP MAILAD�RE55 CITY ZIP rnvnc o�..�����_��.,.- <br />In�r� S�,r Zrnl(5 RBf� �,i. SE �v��r�� I.� 5¢1��^i,.2C�� <br />MECMANICALLONTR Ci MAIL��DRESS CITV ZIP PHONE T ELICENSEn � <br />i� <br />_ TscaN��a�,ti� <br />PLUMBINGCONTPACiOR MFILRDDRE CIiV ZIP PNONE STATEIICENSEv <br />CONTqqLT PFICE OF WORN I <br />DESCRIB� 0� ND SOU� FOOTAGE INVOLVEO CONTACT PERSON AND PHONE NO. <br />PROPOSE� USE OF BUILDING <br />�V�nA " �flm6 <br />I.EGAL DESCRIPTICN OF PROPERTY ISHO IN BELOW OR ATiACH TiYO COPIES� <br />LOT 9LOCK OF <br />PARCELTA%ID.HUMOEF <br />CONSTRl1CTIONLOANLFNDER.P��RESS, <br />____- �_lo / `I <br />1 <br />PIUMBING <br />p, TYPE OF FIXTURE <br />—r WATER CLOSET (TOILET) <br />KIl"CHEN SINK & DIS? <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK <br />TOTAL $ <br />v11T S <br />\L FEE $ <br />�i� FOR OFFICE USE ONLY: <br />FPONT SEiBACN REAR SETI <br />USEZONE LOTAREA <br />,' <br />iYPE Of CONSi. <br />S�ZE OP BIDG. <br />OCCUPANCYLOAD <br />REASON <br />INTAKE BY <br />NO. OF 5T <br />FIRE gaqWNLERS FE00 <br />FIRE ALARM REO'D <br />V' <br />DATE ,�/- ia - <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TFIIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC L ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPCCIFIED HEREIN OR <br />NOT. THE 3RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OP CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW RE3ULATING CONSTRUCTION OR THE <br />PERFORI�7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TC! PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COKTRACTORS LAW 1827 RCW ANU 296200 WAC. <br />TYPE OF EOUIPM <br />A/C—AiHNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYER� <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLAGE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />FXHAUSTFAN <br />SE78ACH � PLANCHECH <br />VFCANT SITE - <br />^i YES ^'. N� BUILDING <br />occuratin uoorc::rwucuv�rs <br />cnou= pWMBING <br />OnSEMENT MECHANICAL <br />❑ YES �; NO <br />HEIGMT LiMITATiON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUIL�ING SURCHARGE <br />CITY OF EVERETT PU�LIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />M E.A. <br />� <br />TOTAL 5 <br />NIT S � <br />\L FEE 5 <br />RECEIPT NO. <br />JATION F'-�E_r_ <br />i <br />i <br />� <br />_ —�r_ <br />