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APPLICATION FOR CONSTRUCZION PERMIT � <br />TO B► ,OMPLETED IN BLACK INK-PLEASE F...AT <br />HEATING SYSTEM: 0 GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />GENERALCONTqACTOR MA�LADDflESS GITY 21P PMONE SUTELICENSEI <br />• <br />MEC!{q11CA�CONTRACTUR � MAI�ADDNESS CITV ZIP PHONE STATEUCENSEI <br />CONTA�CT PRICE OF WORK <br />DESCRIBE WORK AND SW AqE FOOTAGE INVOLVED <br />PROPOSEO USE OF BUILDINO <br />LEOAL DESCRIPTION OF PROPERT' ISNONR! BELOW OR ATT�CM TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D.NUMBER <br />CONSTRUCTION LOAN LENOER. ADDRE55, TELEPHONE NUMBER <br />PROJECT ADDRESS <br />�l7o�-D G�55� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />—TWATER CLOSET (TOILC-T1 ' <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRY TfiAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PEAR: <br />TYPEOFCOHSi. <br />512E OF BLDC. <br />OCCUPANCY Li <br />REASON <br />IHTAKE BY <br />PERMIT $ <br />TOTAL FEE S <br />LOT AHEA <br />NO.OF STORIES <br />FIRE SPRINKLERS REOV <br />FIRE ALARM REO'0 <br />PUNS �1PP_ROVED BY <br />DATEJ j�2/2��9ti <br />SIOE SETBACN <br />CITV <br />ZIP PIIONE STATELICENSEI <br />CONTACT PEfl50N AND PMONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF U1WS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIGNS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PHO°ERTY TO PERFORM THE WORN FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x /.� �7;�'� <br />$qNATUPE o�*e <br />MECHANICAL <br />FEE NO. TYPE OF EOUIPMENT <br />� NC—NHNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M <br />� UNIT HEATERS--B.T.U. M <br />� r,LOTHES DRYERS <br />; VENTILATION FAN <br />� RANGEHOOD <br />� WATER HEATER � <br />� WOODSTOVE <br />� METAL FIREPLACE (WOOD BURNINC <br />; FIREPLACE INSERT <br />� HEAT PUMP <br />PUN <br />❑ YES ❑ NO BUILDING <br />OCtUNkCY HO q VMIUHGUNl16 <br />�AOp° PLUMBING <br />BASEMENi MECHANICAL <br />❑ YES ❑ NO <br />NEIGMTIIMITATION ADDITIONALPLANCHECK <br />OiHER / � <br />^ f .(�/ Ea <br />STATC- BUILDI G SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL <br />8 <br />$ <br />Np <br />n <br />Y <br />�y <br />H <br />