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APPLICATIf'W FOR CONSTRUCT-�ON PERMIT <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br />HEATING SYSTEM� ❑ GAS O ELECTRIC ❑ <br />BUILDING DEPARTMENT � <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />ABCHITECTOflDE51GNER MAILADDRESS CITY 21P PHONE <br />GENERQCONTR�CTOR MAILADDRESS GITY 21P PMONE STATELICENSEI <br />AIEClWIICALCONTRACTOP _ MAILAODRESS CITY ZIP PHONE STATELICENSE� <br />M�IL AODRESS <br />CONTR�CT PRICE OF WORN <br />DESCRIBE WOflK AND SW�RE FOOTAGE INVOLVED <br />PROPOSED USE OF <br />�or e�xK oF <br />PARCELTA%I,D.NIIMBEfl <br />CONSTRUCTION LOAN LENDER, ADDilE55, TELEPHONE NUMBER <br />PLUMBIN6 <br />0. TYPE OF FlXTI <br />WATER CLOSET (TOIU <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REARSETBRCN <br />TYPE OF CON57. <br />SIZE OF BLOG. <br />HEASON <br />LOTAREA <br />ITEM <br />PERMIT $ <br />TOTAL FEE $ <br />FIRE SPRINNlERS REO'D <br />FIAE AIARM REO'D <br />CITY 21P <br />CONUCT PERSON AND PNONE NO. <br />PHONE ST�TEIICENSE� <br />1 HEREBY CERTIFY THAT I HAVE READ P.ND EXAMINED THIS <br />APPLICATION AND K�JOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAN'� AND ORDINANCES GOVERNINO THIS TYPE OF <br />coeiesl WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME�TO C,IVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS i RUCTION. THAT I AM AUTHORIZEU 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 />FEE <br />x /d-a�-p� <br />SiONATURE WiE <br />qTv BUSME55 LiCENSE N0. <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />AI�AlFINDLG UNITS—H.P. <br />FOflCED AIR SYSTEMS=B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER ' <br />W000 STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EKHAUSTFAN <br />SIDE SETBRCK PLAN GHECN Nl`1MBEP <br />J� <br />VRCANT SITE FEES <br />❑ YC-S ❑ NO BUILDING <br />acuvwcr xo.aownuxcuwns <br />cnauv PLUM0ING <br />BnSEMEr+T MECHANICAL <br />❑ YES ❑ NO <br />HEIGMTIIMITATION ADDITIONALPLANCHECK <br />OTHER � -l� <br />STATE BUIL ING SURCHARGE <br />SUB TOTAL $ <br />RECEIPT NO. <br />H <br />�NTAKE BV PLANS APPflOVED BY CITY OF EVERETT PUBLIC WORN$ � <br />VI � LOCAL SALES , <br />D�TE ' '� TAX CODE IS 3105 TOTRL �'U ��J <br />