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APPLICATIC l FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPART��AENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC `.1 <br />259-8810 <br />DEMOLITION i i COMBINATION ! I BUILDING i✓MECHANICAL i i PLUMBING SIGN <br />OWIJEF AIAILAODRESS CITV ZIP PMONE <br />� <br />�J..� ijnn�aa ��lls /l'1�9c..en1 L'vf.:� `3`L201 2S.L 61.Z9 <br />TENANT MAILAODRESS � GTV ZIP PHONE <br />qRCM1iECTOR0E51GNER MA:LAODRE55 <br />GENERALCONTRFCTOR MAI�pODRESS <br />GTV ZIP VHONE <br />ZIP <br />M1tEC11ANICALCONTRACTOR MAILAODFESS CIiV ZIP PMONE STC.'CUCENSE• <br />tvpct�tr� 54�'�¢ S/.., f'.O..�i�F IS�S LYYiJ� qs.�.o� i.iJ'3hV f�E�2C+S-sldl)f% <br />PlU INGWNiRACiOR MAILpDORE55 CITY ZIP PNONE ST�TELIGENSEa <br />CONiRACT RICEOFWOFK <br />INVOLVEO <br />PROPOSEnDUSEOF UILDING <br />I�QSi�t kntC <br />LEGAL DESCFIPTION OF PROPERTY �5110W N BELOW OF ATT4CH TWO COPIE51 <br />LOi OLQ:K OF <br />PARCELTA%ID.NUMBER <br />CONSiFUCTIONLOANI <br />N0. TYPE OF FI%TURE OR <br />WATER CLOSET (TOIIET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVF.NTERS <br />ROOF DFAINS—aAINLEAC <br />SINK �SERVIC[ BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGN REAqSETBALK <br />u5E ZONE <br />rvre av cor�sr � <br />yIZE OF BLDG. <br />CCCUPANCV�OFD <br />aEnsoru <br />i4iANE pY <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 TFiIS 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 />AUTHORI-iY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AIiTHORIZED BY 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 18.2i RCW AND 296.200 WAC. <br />IiUMpER /n/ � <br />5! L i , <br />7� /��LLL�+ / �v"� �%�/ <br />SN:NAiU�-� 0�1[ <br />CIIY OUSIN651 iLCNS[ NO <br />MECXANICAL <br />M FEE NO. TYPE OF EOUIPMENT FEE <br />� ArC—AMNDLG UNITS—H.P. <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE $ <br />SIOE SEIBACN <br />LOT�RE� <br />NOAF STORIES <br />FlRE SPRINNLERS REO'D <br />PIqE �IARM FE00 <br />PLANSAPPROVEDBY <br />OFTE <br />0 <br />0 <br />- YES -; NO <br />o:r..�.+cv noamrE�,u�:cv.�:: <br />G�DJ� <br />:- � YES -. NO <br />NEIGNT LI1dl fAT10N <br />CITY OF EVERETT <br />LOCALSAI.ES <br />TAX CODE IS 3105 <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M , <br />VENTILATION FAN <br />RANGEHOOD —�- <br />WATERHEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT , <br />GAS PIPING <br />ExHAUSTFAN <br />NUMBEf+ <br />BUIIDING <br />PLUMBING <br />iAECHANICAI <br />ADDITIONAL PU+N CHECK <br />OTHER <br />STATE BUILDING SUP('HARGE <br />PUBUC WORKS <br />TOTAL <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE 5 <br />