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APPLICATIC ] FOR CONSTRUCT' lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />/�i : <br />- � i;�.`i-. , <br />— .........._. , : i .._. ` <br />HEATING SYSTEM• �GAS J ELECTRIC J C�' ' <br />BUILDING DEPARTMENT � � E� <br />259-8810 P��blic I'Jor�. f Rt T]'...... <br />DEMOLITION I COMBINATION BUILDING �MECHANICAL PLUMBINSG'��Ut. i SIGN <br />o��RYlI'1"-� .�h�r Clsll��ln. 1 1'1u�il 1 Sy�lf Z PHONE <br />�_, ar�,n ,� e _ n �.c� � <br />TENANT�` �� ldA�LAD�RESS <br />11 <br />ARCHIi C OF E5IGNER MAILADORE55 <br />1� �=� <br />GENERALQO�y,TRACTOR h1A1LADDRESS <br />' L� <br />V � <br />�. CMANICALCONTPACTO AIAI AJORE55 <br />� � <br />�P A INGCONTqACTOR �IAIL�DO 5_ <br />1 <br />GO FCT PRIC[ OF WORK <br />��9cz��9' <br />'�ESCRIB WORI NDSOUPOEFWiAGEIN\ 'cD <br />� �t <br />��,,� t n�R. (�;.n, <br />P OP E�USEO1 BUILDING <br />x C1 /lC <br />LE ALDESCRIPTIONOFPROPERTV�SHOWNBELOIYORATTACHTIVOCOPIES� <br />LOT BLOGN Of <br />PARCELTA%ID NUMBER <br />CONSTRUCTION LOAN LEN�EF. AODRE55, iELF.PHONE NU6IBER <br />N0. TYPE OF FI%TURE OR I' <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISH WASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINIEADERS <br />SINK (SERVICE—BAR. ETC.) <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSET�AGH REAR SETBACN <br />USE20NE IOTAREA <br />7VPE OF CONSi NO OF SiORIES <br />52E OF BLDG. FIRE SPRINKLERS REO'D <br />OCCUPANCV LOAO FlPE �I�RM REOD <br />REASON <br />INTANEBV PLANS�PPROVEDDY <br />r,nrE <br />CITY ZIP PNONE <br />�ir� <br />PHONE <br />CIN 21P PHONE STAiELICENSEt <br />�TY ZIP PNONE SIDTE UCENSE � <br />�� � �k� � �, �1�� 2r�r��,� .��s- >> o�� �n� <br />C��— ZIP PHONE STATE LICENSE e <br />PERSONFND <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINC-D 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 OF <br />NOT. THE GRANTING OF A PERMIT DO[S NOT PRESUME TO GIVE <br />AUTriORITY TO VIOLATE OR CANCEL THE PROVIaIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR�7ANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP-ICATION IS MADE AND I COMPLY WITH THE STATE <br />CO TRV�CTORS LAW 18.27 RCW AND 296.200 WAC. <br />� <br />� V <br />\-..` L C�. C cJ C�t-' <br />s�� , � e o+i[ <br />MECHANICAL <br />NO. TYPE OF EDUIPMENT <br />A�C—A�HNDLG UNITS—H.P. <br />_� FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />� CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER <br />WOOD STOVE <br />� METAL FIREPLACE �WOOD BURNIN( <br />FIREPLACE INSERT <br />� HEAT PUMP <br />GAS PIPING _ <br />� EXHAUST FAN <br />SIpESETB�CN PL�NCHE(' MBER � <br />VACANT SITE FEES <br />� � YES . . NO BUILDING <br />ocwrevcr r:oo�w+uuvcmn•s <br />taauv pWMBING <br />BnSEMENT MECHANICAL <br />1- YES �,: NO — <br />HEiGHr ur.urnnoH ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />PERMIT <br />TOTAL FEE <br />S <br />RECEIPT NO. <br />