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APPL�CATIQ�' FOR CONSTRUCTf"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEAT�NG SYSTEM� �GAS �J ELECTRIC 'J � <br />BUILDING DEPARTMENT <br />259-8810 <br />7 DEMOLITION = COMBINATION <br />G'NNEq �7�' MAILA�OqE55 <br />^[%(I.JFi�� lOIZl�'L r� �� MlT <br />TENRNT MAILApORE55 <br />ARCHITECTORDESIGNEF IAAILAO�FE55 <br />IAECHRNICFLCONTRACTOR MAILp�ORE55 <br />PWMBINGLONiFALiOR MAILAOORESS <br />CONTqApT PPoCE OF WOR� <br />�FSCRIBE WOPH AND SOUARE FOOTAGE INVO�JED <br />PHOPOSEDL'SEOFBUILDING ^ <br />i <br />LEGAL DESCRIPTION Of- PROPERTY �SI <br />L0T BLOCK — <br />[ 1 BUILDING <br />CITV / <br />- 6'G(C-4 <br />cin <br />CITY <br />qTY / <br />vz „a C% <br />CITV <br />CITV <br />LOW OP ATTACM TWO COPIES� <br />OF — <br />PARCELTFXI.D.NUMBEF <br />CONSTplILT10N LOP9 LENDER. AODRE55. TELEPNONE NUMBER <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />DRINKING FOUNTAIN <br />FLCOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--FAINLEAC <br />FOR QFFICE USE ONLY: <br />FFONTSETPALK qEARSETBACK <br />iVCE Of CON57 <br />SIZE OF BLDG. <br />REASON <br />MTAKE BV <br />PERMIT <br />TOTALF <br />FIRE SPPINKLERS REO'0 <br />PLANSAPPROVEDBY <br />DATE <br />FEE <br />0 <br />XMECHANICAL <br />Z`IP 1 PHONE <br />I'�7Ci � �a' <br />ZIP PHONE <br />2iP PHONE <br />LiY PMONE <br />i��c+C � s5- <br />ZIP PHONE <br />ZIP PHONE <br />CONTA6T ?f:R50N AND PHONE NO. <br />❑ PLUMBING ;' SIGN <br />STPiE UCENSE n <br />STFTt LICENSE • <br />i��EREBV CERTIFY THAT I HAVE READ AND EXAMINELI THIS <br />ArPLIC.ATION AND KNOW THE SAMF TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCL-.5 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WH[THER SPECIFIED HEREIN OR <br />NOT. THE GR�INTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFITY T7 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE f)R LOCAL LAW REGULATING CONSTRUCTIOtJ OR THE <br />PERFORMANCE� OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI:: PR�?PERTY TO PERFORM THE WORK FOFi WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STAiE <br />CONTRACTO S �LAW 1827 RCW AND 296.200 WAC. <br />X c.'^�``(F'C-- �oC-� ^�� � �" ��. _ <br />IdECHANICAL <br />N0. TYPE OF EOUIPMENT <br />A,'C—AiHNDLG UNITS—H.P. <br />1 FORCED AIR SVSTEMS-6.T.U. <br />UNIT HEATERS—B.T.U. A4 <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURI <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SIDESETBACK PLANCNEGNNUIdG'eR FF.E <br />VACANT SIiE FEES <br />LJ YES G NO BUILD:NG <br />nccuPar�cr uoaoNmmcum�s <br />caou� p�UMBING <br />BASEMENT MECNANICAL <br />�i YES C NO <br />HEiGHi tIMRATION A�DITIONAL PLAN CHECN <br />OTHER <br />S7ATE BUILDING SURCHARGE <br />CITY OF EVERETT ruouc woaKs <br />LOCAL SALES <br />TAX CODE IS 3105 TO7AL <br />E.A. <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />�X <br />A <br />