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APPLICATIO� FOR CONSTRUCTi�N PERMIi ���� <br />TO BE COMPLETED IN SLACK INK—FLEASE PRINT <br />BUILDING DEPARTMtNT <br />259-8810 <br />I D MOLITION � i COMBINATION <br />QWNER MAILADORE55 <br />� �x�-f . G�Q 6 <br />lcuee�r . MAILADDRESS <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ __ <br />I ! BUILDING !JMECHANICAL XPWMBING <br />CITY ZIP PHONE <br />s� �.a- �.� Z�.3 a yo - f v� <br />CITY ZIP PHONE <br />I i SIGN <br />ARCMITECT OR OESIGNER MAIL AD�RE55 CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL AODRLiS CITV ZIP PMONE STFiE LICENSE P <br />�orYp11 �.onST �UcrcT <br />MECHANICAL WNTPACTOR MAIL ADORESS CITV 21P PHONE STATE LICENSE Y <br />PLlIM91NG CONTRACTOR MAIL ADORESS GTV ZIP PHONE S1ATE UCENS[ R <br />p 6 3/2 f9ap/c'�/�l Snohor+�al, gg290 5G8-G/sS tJN=r��A�77DLi <br />�,�Jti;re Coasr fum �n — <br />CLASS OF WOFK , <br />�(NEW !! ADDITION � i ALTERATION i'� REPAIR I'� DEMOLITION I�. WOODSTOVE/FRPL INSERT ��� BUILDING RELOCATION <br />I WNTACT PLRSON AND PHONE NO. <br />f� � </_0. ././iS- <br />GONTPACT PriICE Gf WORK <br />OESCRIOE WORK AND SOUPflE <br />PROPOSED USE OF BUILDING <br />�EGFL D[SCRIPTION OF PROPE <br />LOT BLOCK <br />oF <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSE7 lTOIL =T) <br />BAIHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRl�.Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DIi�INS—F7AINLEADERS <br />TOTAL 3 <br />MIT $ <br />4L FEE $ <br />FOR OFF�CE USE ONLY: <br />USE ZONE <br />TVPE OF CONiS. FL104 <br />SIZE OF BLDG. <br />OC W PANGV LOAD <br />REASON FOR SPRII <br />iNTAKE BY <br />NO.OF <br />FlRE <br />PLANSAPPROVED9Y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANC KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEfiMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCFL 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 PROPERTV TO PERFORM TH[ WORK FOR WHICH <br />APPLICATION IS MADE ANG I COPdPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x ,'� .ti �C- .�i�t.�+r� /— 7— 902 <br />SIGNAiUYL 4 � OAIE <br />! <br />FEE <br />SETBAGK <br />MECHANICAL <br />10. TYPE OF EOUIPMENT FEE <br />��ED AIR SYSTEMS—B.T.U. M <br />HEATERS—B.T.U. M <br />HESDRYERS <br />�. RANGEHOOC <br />WATER HEATER <br />, .— WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />', FIREPLACE IPlSERT <br />HEAT PUMP <br />GAS PIPING <br />� EXHAUSTFAN <br />aS <br />VACFNT SITt <br />BUILDING <br />oauruxr �.ac=oununrwurs <br />cAoua ' pLUM81NG <br />BaSEMENT MECHANICAL <br />MEIGHTLIMITATION ADDITIONALPLANGHECK <br />SPRINKLER <br />STATE BUILDING SURCFIAflGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTALFEE 5 <br />y <br />