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APPLICATIC�~7 FOR CONSTRUCT'`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM• ❑ GAS ❑ ELECTRIC �I <br />BUILDING DEPARTMENT � � <br />259-8810 <br />DEMOLITION I I COMBINATION I i BUILDING �/dECHANICAL ! iPLUMBING I i SIGN <br />OVNFR �1NLpDOFE55 CIiY ZIP PHONE <br />�ta��3��'i �lx).ef 1� �"E—����.��125 S'L�-2'j� � <br />1[NANT MAtLp�01i[SS CIIY ZIP PHONE <br />ABCHII ECi ON DESIGNER <br />G[NERALCONTRqCiOR <br />IANL A�ORESS <br />MAIL ADDRESS <br />CITY ZIV PHONE <br />ZIP PHONE STAiE LICENSE • <br />MtCHRNIGAICONTRAf.TOFl M�ILAD�RE55 CITY ZIP PHONE STAIEIiCENSE� <br />DW NC��� <br />PLUMOI4GWNiRACTOR hNILpODRESS pITV ZIP PHONE STATEUCENSE+ <br />CONTRACi PflICE OF WORK <br />DESCRIBE WORK AND SOUARE FpOiAGE INVOLVEO <br />PROPOSED 11SE OF BWIDIYG <br />LEG�L OESCRIP'iON OF PROPERTV ISNOWN pElO\4 OR ATfnCH TWO GOPIES� <br />LOi BLOCN OF <br />PARLELTA%ID.NUMBER <br />GONSTBUCTION LOAN LEH�ER. A��PE55, iEIEPHONE NUM1I�ER <br />PROJECTADDRESS <br />TYPE OF fIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUN <br />LAVATORY (WASH BASIN) <br />SHOWEF <br />NITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK fSERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />�RONi5ET0AGH pEAFSETBACN <br />❑SEZONE IOTAREF <br />iYPE Of LONSI NO OF SiORIES <br />SRE OF BLDG. FIRE SPRINNLERS REO'D <br />FiPE ALAqI.I qE0 D <br />F[ASON <br />INiAKEBV I PLANSAPPROVE�BY <br />im�a <br />S <br />WNTACT PEFSON AND PHONG NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED 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 HER[IN OR <br />NOT. THE GRANTING OF A P[RMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OP THE <br />PERFORMANCE OF CONSTRUCTION. T4AT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br />CONTRACTURS LAW 1827 RCW AND 296200 WAC. <br />,�_,��__��� _ 9 t � � <br />sr.rn�� _ o it <br />FEE NO. TYPE OF EOUIPMENT <br />AiC—A'HNDLG UNITS—H.P. <br />; FORCED AIR SY£TEMS—B.T.U. M <br />� UNIT HEATERS-9.T.U. M <br />VENTILATION FAN <br />�_— RANGE HOOD <br />,— WATER HEATER <br />� WOODSTOVE <br />! METAL FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SiDESEtpACK I PLANGNEGNI <br />VACANT SITE FEES <br />-i YES ❑ NO BWLDING <br />oauru.cr r,�,�n�tu�xauxns <br />L5�'�� PWhf�ING <br />onSEMENi IdECHANICAL <br />C YES l NO <br />HEIGHTLIMITATION ADDIlIONAL PUN CHECN <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT pU8LICIHORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />FEE RECEIPTNO <br />VALUATION FEE <br />_� <br />_ i <br />_ _� <br />