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APPLICATIC-1 FOR CONSTRUCT' 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: � GAS G ELECTRIC ❑ � <br />259-8610 <br />C: DEMOLITION I_i COMBINATION i� BUILDING �MECHANICAL f�PLUMBING i=1 SIGN <br />01VNER <br />nn � <br />PWA181NG <br />GONTPFLT PRiCE OF WORK <br />��r�rY <br />OESCRIBo WORN AN� SOU�RE <br />MFIL �D/D/RE,55 <br />MAIL A ob aess <br />MAIL ADDRE55 <br />lAAIL AODRE55 <br />AIL A[1DRE55 <br />CITV /��/ ZIP1 PHOYE <br />Cnl1t1/-,Qii fill i If�F�-"Ti �X71�{ .�.�1' <br />PROPOSED USE OF BUILDINU <br />LEGRL DESCRIPTION OF PpOPEI1TY �SNOWN BELOW OR ATTACH TlYO COPIES) <br />L0T BLOCK OF <br />PARCELTA%ID.NUMBER r <br />LJ Z Q'1 � L� \ � <br />NIIMBEP <br />N0. TYPE OF FIXI�UFE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEF <br />KITCHEN SINK 8 DISP <br />DISNWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />PERMIT i <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK RE�RSETBACK <br />USEZONE LOTFNEA <br />iYPE Of CON51. NO. OF SiORIES <br />512E OF BIOG. FIRE SPFINKIEBS RE00 <br />OCGUP4NCY IOAD FIRE ALARM RWD <br />MTPNE BY PLANS AP�ROVEb OY <br />DATE <br />CITY ZIP PNONE <br />CITY ZIP PM� � . ST�IT�ICENSEn <br />I <br />'�1=� A q�t�i?ti�- oa ;�,=cT wtf� <br />ITY ZIP PH01JE STATE LIGENSE s <br />CITY Z!P PHONE STATELICENSEs <br />I HEREBY CERTIFY THAT I HAVE READ ANO EY.AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFiECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GHANTING 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 />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION D AND I COMPLY WITH THE STATE <br />CONTR 5 LA 27 W AND 29 200 WAC. <br />� `_i/� <br />sicrurunE � <br />ND. TYPE OF EOUIPMENI ree <br />A/C—A/HNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U(�M E.A. —'� <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS ' <br />VENTILATION FAN <br />RANGEHOOD <br />WATER FIEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEf.T PUMP <br />GAS PIPING � <br />EXHAUSTFAN <br />SIOESETOACK PLANCHECKNUMtltn <br />/ <br />SC7�? ) `.� <br />VAGANT SIiE FEES <br />�-�� VES I 1 NO BUILDING <br />(g�pfAM1Lv 1100«.VLLI'NGtI'lli5 — -- <br />caou� PLUMBING <br />BnsEMENi MECHANICAL <br />;—. VES � �. NO <br />HEIGM7UMITATiON AODITIONALPLANCHECK <br />OTHER <br />STATE BUILOING SU(iCHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX COOE IS 3105 rora� <br />SUB TOTAL S ; <br />PERMIT $ <br />TOTAL FEE S , <br />N0 <br />i <br />� <br />7 <br />