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-. _. <br />APPLICATION FOR CONSTRUCTION PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDWCi DEPARTMENT j HEATING SYSTEM: f9'GAS ❑ ELECTRIC 0 I <br />259-8810 � <br />i� DEMOLITION '! COMBINATION BUILDING NiAECHANICAL L! PLUMBING f 1 SIGN <br />OWN / AI/ILADD9ESS dTY ZIP PHONE <br />.v.✓ /yCs✓l��a S/,3,'3 occ.c�+�/� 6,.t��f 9�e�23 3Y'7- S3e2o <br />TENANT MAILAODRE55 aCITV 21P PHONE <br />AflCHITECTORDE5IGNER MRILADDRESS GTY ZIP PHONE <br />GENERAL CONTRRCTOR MAIL ADORt55 CRV 21P PHONE STATc IICENSE � <br />MEGHANIC�LCONTRACTOR MAILqDDRE55 CITV ZIP PMONE STfTEUCENSE• <br />Er�uc�,v s�res.�r.yr1 i�i/E.�r�re;�d,ov�,_c��r �P�oi as�-�ii�' 6V�ass.a�K� <br />PLUMBING CONTFACTOR MAIL ADJRE55 CITY � 21P PHONE 5T4TE UCENSE � <br />PRICE OF WORN <br />a <br />fOFK AND $OUARE <br />LEGRL DESCRIPTION OF PROPEPTY �SNOWN BELOW OR AiTACH TWO GOPIES� <br />LOT BLOCN OF - <br />� PAPCELTA%ID NUMBEN <br />� CONSTRUCTIONLO�NIEt <br />� PROJECT ADORESS <br />PLUMBING <br />N0. TYI <br />WATER CL <br />BATHTUB <br />LAVATORY <br />R. ��DRE55. TELEPHONE NUMBER <br />%3� �R� �u� <br />OF flXTURE OR ITEM FEE <br />ET (TOILET) <br />ASN BASIN) 1 <br />KITCHEN SINK 8 <br />DISHWASHEF <br />LAUNDRYTRAY <br />UiiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—fiAIN <br />S�NK ISERVICE—BAF <br />0 <br />SUB TOTAL S <br />FOR OFFICE USE ONLV: <br />FRONT SETBACK REAR SETBACK <br />USEZONE LOTAPER <br />TYPE Of CONSi. NO.OF STORIES <br />SRE Of BIDG. r IRE $PBINKLEdS REO'D <br />OCCUPANLY LOAO FIRE AIARM REO'0 <br />REASON <br />INTAKeBV I PLANSAPPROVEOOV <br />DATE <br />SIDE SE7D4CK <br />CONiACT PERSON AN� 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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEiiEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br />PERFORh7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND � COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />s.n.*un� / ��o�^�� <br />TYPE OF E�UIPMENT FEE <br />!VC—NHNDLG UNITS—H.P. _—� <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UNIT IIEATERS—B.T.U. M <br />CLOTHES DRYERS ' <br />VENTILATION FAN ; <br />RANGEHOOD <br />WATER HEATEF <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT � <br />HEAT PUMP <br />GAS PIPING � <br />❑ YES ❑ NO BUILDING <br />OCCU>ANLY NO OibNFIIiNGI1Nrt5 <br />cnour pLUMBIflG <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHcR <br />STATE BUILDING SU9CHhRGE <br />CITY OF EVERETT PUBLIC WOPKS <br />LOCAL SALES <br />TAX CODE IS 3105 ror�� <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE � RECEIPTNO. <br />�y <br />9 <br />