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A <br />APPLICATIC"'1 FOR CONSTRUCT'�1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC U_ <br />259-8810 <br />❑ DEMOLITION C COMBINATION CJ BUILDING �JMECHANICAL i�PLUMBING ❑ SIGN <br />OyINER N�ILAODRESS f�ITY 21P _ PHONE _ <br />TENANT IAPILADDRESS � CITY 21P <br />�FCHITECTORDESIGNER MAIL�UDRE55 CITV ZIP PHONE <br />GENERRL CONTflRCTOR MFIL AODPESS QTV ZIP PHpNE STATE LICENSE t <br />MECMANICQCONTRACTOR MAILADDRESS CITv ZIP PMONE ST�TEI�CENSEI <br />P UM8INQCONTRACTOR MAILADDRESS GTY 21P PMONE STQELICENSE• <br />1�(�1,���e Sra--m E as R/� ✓� <br />CONTRACT PRICE OF WORK I <br />OESCRIBE V/ORK AND SOUARE FJOTAGE INVOLVED CONTACT PEflSON ANU PNONE NO. <br />PROPOSED USE OF BUILDING <br />LEO�L OESCRIMION OF PROPEI7TY �SHOWN BELOW OR ATiACX TWO COPIES� <br />LOT BLOLK OF <br />PARGELTA%I.D.NUMBER <br />consrnucriov �wr+ien <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />UUNDRY TRAY <br />CLOTHES WASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFlCE USE ONLY: <br />USE20NE <br />nr� or consr. <br />SIZE OF BLDG. <br />OCCUP�NCYLORD <br />REASON <br />INTAKE L Y <br />LOT AREA <br />FIRE SPRINKLEflS REO'D <br />FIRE ALARM REO'D <br />PLANS APPROVED BY <br />onre <br />i HEREBV CERTIFV 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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY 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 AUTHOHIZEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH TH� STATE <br />CONTRACTORS LAW 18.27 RCW AND 296 2 WAC. /.1 <br />�� �� 4��i��c���rs'�°*� <br />it.... i/ . L.. � <br />A/�A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFRN <br />VACANT SITE FEES <br />G YES C NO BUILDING <br />UCCOD�ACY NOIXDWEIlING11NItS <br />GNWP PLUMBING <br />B�SEMENT MECHANICAL <br />G YES ❑ NO <br />MEIGHTLIMITA710N ADDITIONALPLANCHECI� <br />OTF+eR <br />STATE BUILOING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 TOT�� <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE S <br />RECEIPT NO. <br />FEE <br />