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APPLICATIQ'` FOR CONSTRUCTt"'ON PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />BUII.DING DEPARTMENT <br />259-6810 <br />f 1 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING f I SIGN <br />CWNER AILAUOFE55 CITY ZIP PHONE <br />I'h4l{. B c��wr„� a�!(c Ifu�h,ev� E"�.�xvcL`� tl�4a�► 4P"?�, aJ'fi^�Y,�'_ <br />TENANT MAILA�DRE55 QTV ZIP PHONE <br />AHCHITECT OR DESIGNER MAIL ADORESS CITY ZIP PHONE <br />GENERALCONTRqCTOR MAILADURE55 CIN ZIP PHONE STRTEUCENSE• <br />MECMANICALCONTRACTOR <br />/ _ _ � <br />MAIL ADDRE55 <br />CONTRRCT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOIVED <br />GIIY ZIP VXON! S1PTE4GENSE/ <br />� PROPOSEDUSEOFBUILDING <br />i <br />tEGAL DESCRIPTION OF PROPERTY ISHONM BEIOW OR ATTACH TWO COPIES� <br />� lOT BLOGK OF <br />P�FCELT�%I.D,NUMBER <br />CONSTRUCTIONLO�NLENDER.ADDRESS. <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS--RAINLEADERS <br />SINK (SERVICE-BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSET9ACK FEARSETBRCK <br />USE ZIXJE <br />ivPE Oi CONST. <br />SIZE OF BLIX'i. <br />OCCUPANCYLOAD <br />REASON <br />NUMBER <br />FEE <br />TOTALFEE $ <br />NO. OF STOflIES <br />FIRE SPRINKLERS REO'D <br />PUNS AGPROVED BV <br />DATE <br />SIDE SETBAGN <br />ZIP PHONE STATE LILENSE 1 <br />CONTACT PEflSON AND PHONE NO. <br />I HEREBY CERTIFY 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 GOVERNIN6 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 CONSTHUCTION OR THE <br />PERfORMANCE OF CONSTRUCT�ON. THAT I AM AUTHORIZED BV 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 18.27 RCW AND 296. 0 WAC. <br />y7i � Q <br />TUPE W1E <br />G BU9MESSLICENSENO <br />MECMANICAL <br />NO. TYPE OF EOUIPAAENT FEE <br />NC-NHNDLG UNITS-H.P. � <br />FORCED AIR SVSTEM�B.T.U. M E.A. � <br />UNIT HEATERS-B.T.U. M � <br />CLOTHES DRYERS � <br />VENTILATION FAN ; <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT � <br />HEAT PUMP � <br />GAS PIPING � <br />❑ VES ❑ NO BUILDING <br />SNMNLY NOMPMII�NGIM�15 <br />tAouo pLUM81NG <br />BASEMENT MECHANICAL <br />❑ VES ❑ NO <br />HEIGHT LIMITRTION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAIf CODE IS 3105 �TAL <br />FEE <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE $ <br />� <br />