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,�� �, , APPLICATION FOR CONSTF�U'CTI�JN PERIVIIT ��� <br />TO BE COMPLETED IN INK—PLEASI= PRINT <br />cnvor- <br />everett - - - --�] <br />I-ILATING SYSI EM: IJ GAS U[LECTHIC U__..._ _ ----- <br />BUILDING DEPARTMENT I---------- -- <br />259-8810 <br />I DEMOLITION i � COMBINATION i! BUILDING _� MECHANICAL i � PLUMBING I I SIGN <br />owr�ea ------�.�nn nnni�r.ss "------- ciiv zie ruoNe <br />�,,,a.� la;_f4�✓----�-�°S.-L�,.,.�, �[;dS.J_�ld__..��1t -_`1y��5----�= ��� �Y <br />TFNANT h1AlI.A[)�flESS CIIV ZIP FIIONE <br />pRC111iECT OR OESIGNEfi I.IAII AOORESS CIIY ZIP PIIONE <br />GEIlERALCONfRACTOR IAAILADDRESS CITY ZIF P110NE IICENSEN <br />,L MEf 1 ICAL CONTRACTOR IdAIL A/L�D�flE55 CITY Z�P PIIONE LICE/f�lSE N <br />� DR.�"u/ it'.� /���,'� 3//'J�__I{TCC sr E✓T %�'�O/ ZS%'5�3�/ �%/U.�fltc✓H�O?22 <br />L�% _ — <br />PIUh101NGCOtlTfiaC10R IdAILAOpN[SS CITY ZIP PIIONE IICLNSEe <br />CLASS OF 1'VORK <br />�� NEW I I ADDITION I I ALTEHATION i I REPAIR I I DEMOLI710N I i WOODSTOVE/FRPL INSERT I i BUILDING RELOCATiON <br />O� CON7ACT P[Ii50N AllO PHONE NO <br />`NTRr1CT PflICf OF WORK <br />ncccAiP[ W�RN AND SOIIAl1E I IA� I W OLVE� <br />PROPOSED <br />�(n <br />LEGALDES <br />LOT, <br />nnoness <br />��� � <br />OF PROPEFT' (SHOWN OELo1 <br />oiocH oF <br />WATER CLOSET (- <br />BATHTUB <br />LAVATORVIWASH <br />SHOWER <br />KITCHEN SINK 8 [ <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOl <br />FLOOR DRAIN <br />FOR Of-FICE USE ONLY: <br />FFlONTSE7BnGK REAP: <br />�i WNiS AIIOWARIE <br />OF�I�G <br />.IPANCY LOAD <br />. PEASON FOfl <br />INTANE �Y <br />OR ITEM <br />7YPE Of COt!$i. ACIIIAI. <br />110 OF STORIES <br />FIRE SPRIlNLEF75 flEG <br />PLANS APPAOVEO OY <br />)TAL $ <br />r s <br />FEE $ <br />sioe <br />I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TU BE TRUE AND CORRECT. ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPEC.IFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT P�aESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRnVIS�ONS OF ANV <br />OTHER STATE OR LOCAL LAW fiEGULATING CONSTRUCTION OR THE <br />PF.RFOFiMANCE OF CONSTRUCI"ION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFOR�A THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RGW AND 296.2001NAC. <br />&iGHAl11REOPC01lfflAGTORORAU1110RIZF0AGEN( O�IE '�/Z f+/�/ <br />X �'1. �ti �v r�.-, <br />APPLIC�NTS QiV plI5ME5S �:[HSE N0. A��D DOSING55 N�IAE <br />FEE NO. TYF'E OF EQUIPMENT <br />—� A/C—A/IiNDLG UNITS—H.P. <br />_L FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT IIEATERS—B.T.U. M <br />CLOTHES DRYEHS <br />: VENTILATION FAN <br />I1EAT PUMP <br />GAS PIPING <br />EXHAUSTPAN <br />SUB TOTAL 3 •r� <br />PERMIT S / <br />TOTAL FEE S S <br />PLANCIIECKNl11A8ER FEE I REG@IPTNO. <br />BUILDING <br />(I[CIII'A11LY xoao�uumcuru�s <br />LI�tNiP rwMawc <br />13nSE1AENT lAECIIANICAL <br />IIEIGHTUMITF.TION ADI7ITIONALPLANCHECK <br />OTHER <br />STATE BUILOING SUFiCIiAFiGE <br />CITY OF EVERETT pUBI.IC WORKS <br />LOCAL SALES <br />Tax cooe is sios TOTAL <br />—r— <br />i� <br />S S i <br />i <br />SS�' <br />