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APPLICATIO"' FOR CONSTRUCTf �N PERMIT ��► <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �'�T <br />HEATING SYSTEM: ] GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I! DEMOLITION i 1 COMBINATION I,' BUILDING 1CMECHANICAL y<PLUMBING I' SIGN <br />OW��Eg� MAILADDRE55 CITY ZIP PMONE <br />��X r.� �Suxli.r Si o� 5s'� c'uc>�- �t 4+26�s— 3 3 V 7� 2 S _ <br />TENPNT MRILApDRE55 diY ZIP PHONE <br />APCHREC�OROESICNER MFILADDRESS QTY ZIP PHONE <br />GENERALCONTRACTOR MAILADDRESS GITV ZIP PNONE STATEUCFNSE• <br />��ls <br />MECHANICALCONTIACTON MAI�ADDFiE$5 LITY ZIP PHONE STATEUCENSE• <br />PLUMBING CONTRACTOR MAIL ADORESS CITV .'IP PHONE STFTE LICENSE � <br />CpNTRpCT PRICE OF WORK <br />PROPOSED USE OF BUIL�ING <br />�OT BLOCK <br />GAflCELiAXID.NUMBER <br />N0. TYPE OF FIXTI <br />WATER ClOSET�TOIL� <br />BATHTUB <br />� LAVATORV�WASH BA: <br />SHOWEFi <br />� KITCHEN SINK 8 DISP <br />DISHWASHER <br />I,AUNDtiY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />ROOF DRAiNS—RAINI <br />SI4K (SERVICE—BAR, <br />INVOLVE� <br />10� <br />CONTAGT PERSON AN� PHONE NO. <br />�'Y'��7 �C �� I HEREBY CERTIFV THAT I HAVE READ AND ExAMINED TliIS <br />��� APPLICATION AMD KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS Of LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />BELOWORATfRCHTWOGOPIES� WORK WILL BE COMPLETED WITH WHEI'HER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />— oF qUTHORITY TO VIOLATE OR CANCEL THC PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE 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 yCqOMPLY WITH THE STATE <br />CONTRACTORS LA�AI� 620 WAC. <br />IIEPNONE NUMBER <br />. � .. �� o.,� <br />►�IdV 4 i�Y3 <br />FEE I NO. <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACH RE�RSETBACN <br />USE20NE LOTAPEA <br />iYPEOfCONSi. NO.OFSTORIES <br />SREOF�LOG. i1RESPRIIIKLERSREO'D <br />OCCUPANGY LOFD FIRB AV �:�A RPOD <br />REASON <br />INTAKEBY I PLAN54PPROVEDBV <br />DATE <br />�YL'L <br />/UC—A�HNDLG UNITS—H.P. <br />FORCED Alq SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FP�! ' <br />—i <br />RANGEHOOU <br />WATER HEATER , <br />METAL FIREPLAGE I <br />FIREPI >CE INSERT <br />HEAT PUMP <br />TOTAL <br />$ <br />NUMBER I FEE � RECEIPTNO. <br />VACANT SITE FEES <br />� YES ��! NO <br />BUILDING <br />a::io�xcv co or mvnrvevurs <br />tnouv pl UMBMG <br />BrSEMEHr MECHANICAL <br />i=: YES ❑ NO <br />HEiGMiuMrtnnoN ADDITIONAL PLAW CHECK <br />OTHER <br />STATE BUILDING SI�HCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3705 TOTA� <br />� <br />�L <br />