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APPLICATIO. . FOR� CONSTIRUCT� �N I�ERMIT �� <br />TO BE COMPLETED'1N BLACK INK—pLEASE PRINT r <br />HEATING SYSTEM• y'xGAS ❑ ELECTR'C Q —� <br />BUILDING DEPARTMENT ' __ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �i BUlLDING ❑ 6AECHANICAL �J�pLUMBhVG ❑ SIGN <br />OWNER MAILA��RESS CITV ZIP PMONET— <br />���)�����'Y�(����-i- -P(N-j�i�l' � ��i�r��� (- �?���Ar�iS�:�)_��'� S�IiPfP� l'l/A (��:��z� 1�; , ;���c <br />'�ANT MAILAODRESS CITV ZIP PHONE <br />^'� �1 <br />APCHITECTOR�[SIGNER MAILAD�RESS CITY ZIP PHONE <br />GENERALCONTRACTOR UAILADOFESS CITV TiP PHONE STATELIGENSEn <br />MECHANICAL CONTRACTOR NAIL ADDRESS CITV ZIP pHOfJE STFTE LICENSE n <br />PLUlABINGCONTRACTOR •AAILADDRE55 CITV IIP PHONE S7ATEUCENSEM <br />C7 UJ\l� � <br />CONTRACT PRICE OF WORN - <br />DESCRIBE WORN ANO SOUAPE FOOTAGE INVOLVED (�� � WNiACT PEBSON �ND PHONE N0. <br />!1.�, ., ' I <br />p V � � � <br />��All��l.�,vi nns� �� l�,(�in�� �/li���L I P, ur� i�,� (Yld �ini lJi��(ll�i In `� �> i� �,� i r� <br />i <br />LEGAL OESCRIPTION OF PROPEFTV �SNOWN BELOW OR ATTACH TWO COPIES� <br />LOT OLOCN OF <br />PARCELtA%I.D.NUMBER <br />CONSTRUCTION LOAN LEI <br />ITEM <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA; <br />SIiQW ER <br />KITCHEN SINK & DISP <br />DISHWASFIER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLG`N PREVENTERS <br />ROOF GRAINS—RAINLEADERS <br />FOR OFFICE USE ONLY: <br />FFONTSETBACN FEA�SETBACN <br />USE20NE LOTARLA <br />'VPE OF COHSi. <br />SIZE OF BLOG. <br />OCCUPANCYLOAD <br />PEASON <br />INTAKE BY <br />SUB TOTAL 5 <br />PERMIT $ <br />FIPE SPRINKLERS REO'0 <br />FIRE ALARM HEOD <br />DATF. <br />FEE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORR�CT. ALL <br />PROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PER611T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROI'ISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT � AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TH[ STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�I���� iI�� � '�� �i <br />��W���,� � � � <br />� <br />SiGNAiURt � OAiE <br />CIiY BUSINE55 LICEN3[ NO. <br />MECHANICAL <br />N0. I TVPE OF EOUIPMENT FEE <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 HEATER <br />WOOD STOVE ; <br />METAL FIREPLACE (WOGD BURNING) � <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING . <br />SI�E SETOFLH PLAN CHECK NUMBER FEE <br />VFCAM SITE PEES <br />i"�] YES ❑ NO eui�DMG <br />OCCUPAtiLv tl00ipylRl�!:GUNIiS <br />GPObP PLUMBING . <br />BnSErd[Nr MECHANICAL <br />i-i YES i � NO <br />HEIGHi ubtITATION ADOITIONAL PLAN CHECK <br />OTHER <br />S7ATE BUILDING SURCHARGE <br />CITYOFEVERETT^ PueucwoaKs <br />LOCAL SALES <br />TAX CODEIS 3105 TOiAL <br />SUB TOTAL S <br />RECEICT NO. <br />: <br />, <br />� <br />