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APPLICATIQ"'1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINA710N ❑ BUILDING [�IMECHANICAL ❑PLUMBING ❑ SIGN <br /> MAIL RDDRE55 LITV ^ ZIP '•� Y� PMONE <br /> o,�E� �L'T�o �''f09' ���JITT �flt�� n�,�� _ <br /> TENANT <br /> MRILADDRESS CITY ZIP PHONE <br /> ��N Z�p PHONE <br /> ARCNITECTORDESIGNER M�IL�DDRc55 <br /> ��n, Z�p pHONE STAtELICENSE� <br /> GENERALCON7MCiOR M�ILADDRESS <br /> �a�fwd►���; c��- q�llk z.CL��N�Faa nI5TaRliiwH lo�v <br /> ���Ul(/�e� c���� S� <br /> ��n. Z�p PNONE STATE LICENSE� <br /> P��p�pMC�pNtq�lC7pp MAR�DDRE55 <br /> COP�TMCTPRICEOFWOHM �� ' <br /> � P yt, gl4 <br /> ��q ypqK� REF GEINVOWED• <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS . <br /> pROPOSED U euaoma APPLICATInN AND KNOW THE SAME TO BE TRUE AND CONRECT.ALL <br /> yY� � PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF � <br /> �E(�,p��q�pTpNpFppppEqry�gNOWNBELOWOR�TTACNM'OCOP�ES� NCT. THE aRANT�INO OF A ERMIT,DO SENOT PRIE3UME TO GI�VE � <br /> �oT BLOGK cF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 0'fHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PI:RFORMANCE OF CONSTRUCT .THAT I AM AUTHORIZED BY THE <br /> OVJNER OF THIS ROPERTV P RFORM THE WORK FOR WHICH <br /> �� � APPLlCAT10 MADE ND PLY WITH THE STA?E <br /> � I PIIRGELTAXI.O.NUMBER CONTRA� CWA D WAC. <br /> � �I CONSTRUC110N IOAN IENDER.MDRESS.TEIEPHONE NUMBEN Ct <br /> tu� <br /> PlIWECT ADDRE88 cm xswess Nse w <br /> PLIIMlNI(i MECNANICAL � <br /> N0. TYPE OF Fl%TURE OR REM FEE N0. TYPE OF ECWPAAEIIT <br /> WATER CLOSET(TOILEn � /VC—AMNDLG UNITS—H.P. ' <br /> �TM�B � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> . UVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M (� ' <br /> ��R � CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP � VENTIUITION FAN }— <br /> � DISHWASHER � RANOE HOOD � <br /> � IAUNDRY TRAY ; WATER HEATER , <br /> �' CLOTHES WASHER � WOOD STOVE � <br /> � METAL FIREPUCE(WOOD BURNING) � <br /> � �R��� ' FIREPUCE INSERT � ' - <br /> ORINKIN6 FOUNTAIN , HEAT PUMP � <br /> ! FLOOR DRAIN ' <br /> � BACKFLOW PREVENTERS ; GAS PIPING ' <br /> i � E%HAUSTFAN � - <br /> � ROOf DRAINS--RAINLEADERS � _ <br /> . SINK(SERVICE—BAR,ETC.) � ; _ <br /> � , <br /> � � <br /> � ' <br /> , — <br /> �� SUB TOTAL S � pERMIOTTA� S / L— <br /> � PERMIT S ' TOTAL FEE S T— <br /> TOTAL FEE S � <br /> FOROFFICEUSE�LY: puNCHEGKNUMBE FEE HECEIP(NO. <br /> FRONT SETB��K RE�R SETBACK SIOE SETBACK � <br /> FEES VALUATION �E <br /> USE ZONE LOT�RE� VACANT SITE i <br /> . ❑ VES ❑ NO BUILDING <br /> i <br /> TYPE Oi CONST. NO.OF STORIES ottuwxr xo d DwFuiNc uxrts � <br /> GRWP PLUMBING —i—� <br /> SIZEOFBLOG. FIRESPPINKLERSREO'D B�SEMENT MECHRNIGIL � <br /> ❑ YES ❑ NO � <br /> XEiGNT uMITATION ADDITIONAL PUN CHECK ' <br /> OCCUPANCY�OAD FIRE ALARM REO'D � <br /> OTHER —j— <br /> i <br /> RE��: STATE BUILDING SURCHARGE ' <br /> i <br /> INTAKE B� PUNS APPROVEO BY CITY^O.F'EVERETT PUBLIC WORKS � <br /> l�l��� i <br /> UATE <br /> TA1I CODE IS 9105 TOTAL � <br />