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APPLICATION FOR CONSTRUCTION PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑_Nf7NE <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION Q( BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OYMER MRIIADDRESS CITV 21P PNONE <br />s�u�:c� ,�6� c IL 3902 IJIGN St L�vERC11" 98�D1 �Sg -18b0 <br />TEN�NT MAI�ADORE55 CITY 21P PHONE <br />S�►� � <br />�flGHITECTOFiDESIGNER MRILADDRE55 . CITV 21P /PHONE <br />MAIL ADDRESS <br />CIXJTR�CTOR MAIL�ODRESS <br />ACT PRICE OF WORaK � <br />.��n�n . <br />LITY <br />��03 'Ives�. S� <br />��r <br />cin <br />l.I/ / �" . <br />LEGAL DESCN�PTION OF PHOPEflTV �SHOWN BELOYI OR ATTACyI <br />c+_" 'j. <br />LO BLOCK � OF �L-��- <br />a-da��rov �b �u�r��rr �,� <br />J�-R%�,�s `F7nc►r 2j N zfl E ir <br />PAJ / b DM�ER��OC �O�l l � 'O�� <br />CONSTRUCTION LWN IENDER, ADDRESS. TELEPHp�E NIM/BER <br />Nol�t� <br />PROJECT ADDRESS 3q v 2�i � N <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF DRAINS—RAINLEADERS <br />PERMIT b <br />TOTAL FEE 5 <br />FOR OFflCE USE ONLY: <br />FPONT'SET^&1CK RERRSETBACK <br />W , � ' <br />USEZONE LOTARE� � <br />f�-� ( f � <br />lYPEOFCONST. NO.OFSTORIES <br />SIZEOFBLOG. FIRESPRINNLERSREO'D <br />OCCUPANCYLOAD FIREALAflMREOD <br />INTAKE BY <br />DpTE <br />4+ns�•re <br />a.,�L <br />S�• <br />SIDE SETB�C� <br />9s�a 33i-� I l0 <br />ZIP PNONE STATEUCENSE� <br />� ' 90 s� NR-ct�' <br />ZIP PXONE ST�TELICENSEI <br />IP PNGNE STATELICENSEI <br />'ERSONANDPX [IE C' �,�y_' ' 1 ^ <br />I1111G ilr � <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 HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL UW 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 1827 RCW AND 296200 WAC. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILA710N FAN <br />RANGEHOOD <br />WATER HEATER _ <br />WOOD STOVE <br />METALFIREPLACE(WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING _ . . . <br />❑ YES '�NO BUILOING <br />octuou1cr xoaowtwrm.�'s - <br />�"a" ' pLUMBING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMIiAT10N ADDITIONAL PLAN CHECK <br />Z�� OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAl( CODE IS 3105 roT�� <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />Xp <br />n <br />�y <br />N <br />