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TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />259-BB10 <br />❑ DEMOLITION ❑ COMBINATION C�BUILDING ❑ MECHANICAL <br />n� RIAIVI�O[1PE55 n A CITV ZIP � PH( <br />❑ PLUMBING ❑ SIGN <br />MECHANICAL CONTRACTOR MAIL ADCRE55 CITY 21P PHONE STATE LICENSE � <br />PWMBINGCONTRACTOR MRILADORESS CITY ZIP PMONE STATEUCENSEII <br />DESI <br />OF <br />� <br />� <br />OF PROPERTV ISHOWN CELOW OR ATTACH TWO COPIES) <br />-.BLOCK —.:--r-- OF <br />PARLELTA%�.D.NUMBER <br />CONSTRUCTION LOAN lEl <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 <br />;LOTHES WASHER <br />IIRINAL <br />LPINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADE <br />SINK ISERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />fRONTSET[�ACK REARSETBACK <br />/� � . <br />TYPE Oi CONST. <br />IYTANE BY <br />SUB TOTAL S <br />PERMIT $ <br />NO.OP STCRIES <br />FIRE SPRINNLERS REO'D <br />Dn7E <br />CONTACT PERSON �ND PHONE NO. <br />I HEREBY CERTIFV THA; 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 GRANTIN3 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 AUTHORIZED BY THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTqACTORS LAW 1827 RCW AND 296200 WAC. <br />v ,�„�4 � ) ����- <br />SN'iN E <br />NO. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />' VENTILATION FAN <br />� RANGEHOOD <br />L <br />' WATER HEATER <br />� WOOD STOVE <br />� METAL FIREPLACE (WOOD BUI <br />' FIREPUICE INSERT <br />� HEAT PUMP i <br />; GAS PIPING <br />� i/ EXHAUSTFAN /// <br />SUB TOTAL S — <br />PERMIT $ � <br />FEE RECEIPTNO. <br />/ �/�o, a c�s� <br />❑ YES ❑ NO BUi�DiNG <br />occuvana NnarowEu�xcuxns — <br />p'� ( PLUMBING <br />BASEMEN7 MECHANICAL <br />_', YES i�0 <br />HEIGHi LIMITATION ADDITIGNAL PLAN CNECK <br />/ <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />7AY Cf111F IS 3105 T�TA� <br />dp <br />np <br />M <br />�.�10 � <br />/� <br />