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APPLICATIO" FOR CONSTRUCT� 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�EATING SYSTEM: ❑ GAS U ELECTRIC ❑ I <br />BUILDING DEPAR7MENT <br />259-8810 <br />I_1 DEMOLITION I! COMBINATION I 1 BUILDING ❑ MECHANICAL ❑ PLUMBING i SIGN <br />OWNER M�IL�DDRE55 CITY ZIP PMONE <br />� �Ue S9,�G� �at a��/�inC�s��a/1 /����aaf� ��a� �fl�o� .�SSy�l_; <br />. <br />TENANT MML�D�RE55 CITY L nr ,..�... <br />ANClIITECTOROESIGNER MNL��ORE55 CITY 21P PNONE <br />r.cucRufnNTPaCT�R MAILPDDRE55 CITY ZIP PNONE STATEUCENSEM <br />MECHANICAL CONTRACTOR MML �ODRE55 CRY 21P PHONE STATE LICENSE �t <br />PWMBINGWNTRACTOR N...IIPDDFE55 CITV ZIP PHONE 57ATElILEN3EI <br />CONTRACT PRICE Of 1'lORK <br />DESCPIBE WORK AND SOUARE f00i�GE INVOLVEOCO }� N L �� CONTACT PEIiSON ANO PMCNE NO. <br />`t�nlo � iN �`r5 <br />PROPOSED E OF B ILDING <br />1�Up�� <br />LEGALDESCRIP ONOfPROPERiY�SMOWNBE�OWORATT�CMTWOCOPIES� <br />LOT B�OC OF <br />�n� �l �/ AI ��, �.�. � �� O/O <br />�����s� %i✓ // <br />PARCELTAXID N BER O� . CCO� <br />CO TRU�T10�1��AN �NOEO UD�SS.TELEPMONEN��!'eEi — <br />., <br />X�.� <br />PROJECT ADD^ESS �r \ � ` Q �� <br />/ � Y) <br />OF FI%TURE OR ITEM <br />LAVATORY(WASH tln: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />URINAL <br />DRINKING F <br />FLOOR DRA <br />BACKFLOW <br />ROOF DRAII <br />SINK (SERV <br />0 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOJJ THE SAME TO BE TRUE AND CORRECT. �LL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN CR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AN1' <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR K'HICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x Y �� �C� ,�� "��`� <br />S�GN�IURE DAiE — <br />firv Ni5NES5lILENSE NO �_ <br />FUC-NHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. _. <br />UNIT HEATERS-B.T.U. M _�___ <br />CLOTHESDRY[RS _ <br />VENTILATION FAN � <br />—�-- <br />RANGEHOOD — <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) ___ <br />FIREPLACE INSERT � ___ <br />HEAT PUMP - <br />GAS PIPING <br />EXHAUSTFAN - <br />SUB TOTAL 5 � <br />PERMIT S � <br />—�— �-- TOTAL FEE S � I I <br />FOR OFFICE USE ONLY: <br />PRONT SETBACN REAR SETBACK / SIDE SETBACl(� FLAN CHEGK NU BER <br />-� � � S , <br />� q -� :� <br />USE20NE IOTAPEA V�CANT5IT FEES <br />D � . � YES ! NO BUILDING __ <br />f- <br />iYP OF 0 Si. NOAFSTp(ifES o:cu�+'x* r,pO�C:IEUN�utirts <br />� �no.m pLUMBING <br />C1 <br />S�ZE p� . �e} FIRESPRINNLERSREO'D ASEh1ENT _ MECHANICAL <br />�QI � ��a1J � : YES � NO <br />O� a%T� / ADDITIONAL PLAN CHECK <br />OCCUPANCYL040 FIREALA MREOD HEIGHTLIMITATION <br />REASON <br />INTAKE BY <br />% Q .�7 O(HER <br />STA7E BUILDING SURCHARGE <br />p�ANS APPROV[D BY CITY OF EVERETT PUBLIC WORNS <br />�I LOCAL SALES <br />o�TE�4/� �/�)T TAX CODE IS 3105 TOTAL <br />� <br />SU6 TOTAL 5 <br />PERMIT S <br />TOTAIFEE 5 _; <br />RECEIPT NO <br />