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APPLICATIQ - � FOR CONSTRUCT'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />'��37 <br />BUILDING DEPARTMENT L HEATING SYSTEM: f�GAS ❑ ELECTRIC ❑ � <br />259-8810 <br />❑ DENIOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />ONMER MAILAD�RE55 CITV ZIP PHONE <br />`8��1 C�,�n� v��h 3`13 _ lii'�N 5�. �vERr_rT qS2�l z5`�—log 94 <br />lENANT M�IL�DDPESS CITY 21P PMONE <br />AHCHITECTORDESIGNEN /MILADORESS CITY ZIP PHONE <br />OENERALCONTRACTOfi MAILADDRE55 CIN ZIP PHONE ST�TELIGENSEI <br />GECH�H CANTiIACTOR M�ILAODIiE55 �;TV ZIP P110NE STIITELICENSE� <br />W¢st�Go�D�+rHec.l, 50� E.fxestln. �Jer��f- 9Qza3 25z-�zc�� Westc,nnza�6v� <br />PL CANTMCT(M MARADDRESS CITV 21P PHONE 57�TELICENSEI <br />CONTHACTPRICE VNRK o <br />� �()P)D, � <br />PROiOSED USE OF BUIIDING � <br />LEWL DESCRIPTION OF PROPERTY 15110MM <br />LOT BIOCK <br />C:7 <br />� PARCELTA%I.D.NUMBER <br />CpNS1pUCTl9! LWN LENOER. ADDRESS. TELEfM�ONE NUMBER <br />� �� <br />3`ti3���,N ST Ev�cr.c�'� 9�2oI <br />KIIIAlIIW <br />N0. TYPE OF FlXTURE OR rtEM FEE <br />WATER CLOSET (TOILEn � <br />BATHTUB i <br />LAVATORY�WASH BASIN) � <br />SHOWER ' <br />KITCHEN SINK 8 DISP � � <br />I � DISFIWASHER ; <br />LAUNDRYTRAY � <br />I CLOTHES WASHER � <br />� URINAL ' <br />DRINKING FOUNTAIN � <br />—r <br />F100R DRAI� ' <br />� BACKFLOW PREVENTERS � <br />ROOF DRAINS—RAINLEADERS � <br />I SINK (SERVICE—BAR, ETC.) ; <br />--r <br />I � <br />� � <br />: SUB TOTAL i ' <br />FOR OFFlCE USE ONLY: <br />F110NTSETBACK REMSETBACK <br />' u9E xaNE <br />I rrv�acaxsi. <br />( SI2E OF BLOfI. <br />'� OCCUPANCYLOAD <br />HEASON <br />FINE SPRMKLERS REO'D <br />DATE <br />SEi&1CK <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 GOVERNIN6 iHIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED 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 />Y�V�h�f/ �O���Q � ��`i`r �F <br />SbM�TU1E OAtE <br />TYPE OF EWIPMENT <br />A/G-AIHNDLG UNIT�-Fi.P. <br />FORCED AIR SVSTEMS--B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEATPUMP <br />6AS PIPING <br />v�cu+t si� �eea <br />❑ YES ❑ NO gUILDING <br />ocnpr+¢r xo.aow[iuxcuxitt <br />��P pLUMBING <br />e�SEUENi MECHANICAL <br />❑ YES ❑ NO <br />NEI6NT IIMITATION ADDITIONAL PUN CHECK <br />OTHER <br />STATE BUILDIN6 SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAI( CODE IS 9105 TOTAL <br />SUB <br />FEE <br />„ <br />� <br />H <br />