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1 <br />, � APPLICATIC 1 FOR CONSTRUCT'-�N F�ERM�T � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT T <br />HEATING SYSTEM: ❑ GAS �- ELECTRIC O_ � <br />BUILDING DEPARTMENT <br />259-8610 <br />-; DEMOLITION I; COMBINATION xBUILDING i I MECHANICAL i 7 PLUMBING CI SIGN <br />owH��lA � • li ��ACORE55� � '_ � -'cir% , Z� i r-�. _ �iHone- - — %ir _ -i n --.. .�-- <br />T[tl�NT 1Af.ILADGRE55 I GiV ZIP PNONE / <br />�J�t� l;n� (9!5 M�G� �. ��,�77-f1a� �6�.�5� -OS3/ <br />ARCHITECTOIi�ES' NER MA�:.A�ORE55 CITY ZiP PHONE <br />fENERFLCONTRhCTOR M/+ILADDRE55 CI1V 21P PMONE STATE�iCENfEs <br />� JI u,c�e U. Cm�,,/�a,{ .�1�� �m„�C�r�i� t—`l�'�r�iL dt�,`i 9s���� �� )�J�`�- �/o/� <br />MECHANCALGONTFACTOR dFILADDRESS GITY ZIP PHDNE ST�TELICENSE> <br />PLUTAB'NGCONTRACTOR MAILAODRESS dTY ZIF PHONE STATEUCENSEk <br />��1 �� <br />LONTFFGT FRiCE OF INOFK <br />� o?S a�L. — .��;�Cd'Crn 17820 <br />OESCflIBE WORN AND SOUFRE OOTAGE INVOLVED <br />�-i .� <br />9 �l , . .rl. /�i� <br />PROPOSGD USE OF �WL�ING <br />LPGAL DESCRIPTICN OF PROPE <br />ioi---- e�ocrc <br />PARCEL TA%ID. NUIdBER <br />PROJECT <br />�SNOW N BELOW OH �T1ACN TWO LOPIES� <br />oF <br />� ��:J..� <br />�' <br />= wmeeea ,� � e� <br />OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHJJASHER <br />LAUIJURY TRAY <br />GLOTHES WASHER <br />URINAL <br />BACKFLOW <br />ROOF DRAII <br />SINK (SERV <br />PERMIT <br />TOTAL F <br />FOR 9FFICE USE ONI.Y: <br />FRONTS[TBACK . RE�RSETpACK <br />ll'> % <br />USEZON� IOTAFE4 <br />� ti � �a <br />iVPE OF CONSi. NOAF STORIE; <br />SR[OFBLLG. FlRESFRINKLERSREO'D <br />'�%i� S f t <br />ro4 F P tK U <br />DCCUPFNGVLOAD FIqEAIARMREO'D <br />/d �(jo <br />REASOt! <br />INT.INE BV PlFNS >PPQ/OV1ED DV <br />oaTE C/ a. �4 <br />CONTACT PERSqN AND PH_ JyE N(� �� �`1��� <br />i�Cfhw�—�� il <br />Y�i)- D.C��w��_—� -�,[o/� <br />i HEREBY CERTIFY THAT i HAVE RFAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAMC T,fI !iE TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHET4ER SPEGFIED HEREIN OR <br />NOT. THE GRANTING OF A P�RMIT DO�-S NJT PRESUME TO GIVE <br />AUTHORITY TO VICLATE OR CANCEL ;HE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING ^CNSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM :,UTHORIZED BY THE <br />OWNER UF THIS PROPERTY TO PERFORM THE V�OflK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WI�H THE STATE <br />CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />on.e <br />NO. TYPE OF EQUIPMENT � FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATEFS—B.T.I �. M - <br />CLOTHES DRYER'i / —r� <br />VENTILATION FAh <br />RANGEHOOD <br />WATER HEATER ' <br />WOOD STOVE % / � <br />METAL FIREPIACE-(VJ09D UURNING) <br />FIREPI.ACF IPJSEHT <br />HEAT PUM <br />GAS PIBI G � <br />� I I EXHAUST FAN <br />SIDESE7BALK PLANCH CKNUM�ER _ � <br />� <br />� <br />YPCA1lT SITE FEES ` <br />C'� YES -. NO BUILDING <br />MTJFlCY HO O��WFIIP;GWu15 <br />�7sFouv � p�U1dBING <br />l� <br />BASEM Ni MECHANICAL <br />� � YES ,-' NO <br />NF.iGNruMi*nrioN ADDITIONALPLANGHECK <br />/'J OTHER <br />STATE BWLDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 5 <br />I RX//JT/i <br />�7� <br />1 <br />