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:.�� �a7 <br />,, ; =i APPLICATIPN FOR CONSTRUCI�"`ON PERMIT � <br />TO BE (.OMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMEN'T HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION _ ❑ COMBINATION ❑ BUILDING �MECHANICAL �PLUMBING ❑ SIGN <br />���e <br />Z�P PHONE <br />TENANT rY AIAILADDflE " _' - <br />y CRY ZIP PHONE <br />AqCNITECTORDE5IGNEF MAILADDHE55 CITY 21P PHONE <br />GAEN'9ALCON^TRACTOfl MAILADDflE55 CIN ZIP PHONE STATELICENSE/ <br />1S � � il� <br />MECM N!CA.C,,,,,,,,,,,,�„ �,�.i�pppq�g5 CITV ZIP PMONE STATELICENSE/ <br />PWMBINGCONTMCTOR MAILADDPESS CITY 21P PNONE STATELICENSE� <br />CONTMCT PHICE OF WORK <br />7ROP(1�F�i�SEOFBt11LDING � j� ��y- <br />�i�,�J[PMX�,dI�.Q <br />LE(3AL RIPTIONOFpROpERTV�SHOWNBELpWOflATTRCHTWOCAPIES) <br />LOT BLOCK OF <br />PAHCELTAXI.D.NUMBER <br />CONSTPUCTION LOAN LEI <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK <br />FOR OFFICE USE ONLY: <br />FpONTSETBACK REAR'. <br />ttPE OF CONST. <br />SIZE OF BLDG. <br />OCW PFNCY LOAD <br />REASON <br />INTiV(E BY <br />TELEPHONENUMBER <br />SUB TOTAL <br />IOTAREA <br />NO. OF STORIES <br />FIRE SPRINNLERS FEO'D <br />FIqE ALARM REp'D <br />PLANSAPPROVEDBY <br />DATE <br />FEE <br />SIDE SETBRCK <br />CONTACT PERSON M10 PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OH CANCEL 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.2� RCW AND 296200 WAC. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />vnc,wi siie FEES <br />❑ YES � ❑ NO BUILDING <br />OCCIIPINCY NO.OfRMIIINGI1NIi5 <br />y�P PLUMBING <br />BnSEMENi MECHANICAL � <br />❑ YES ❑ NO <br />HEIGHTLIMI7AnON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WURNS <br />LOCALSALES <br />TAl( COUE IS 3105 TOTAL <br />FEE <br />$ <br />RECEIPT NO. <br />FEE <br />0 <br />