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APPLICATIQ'°'' FOR CONSTRUCTWN PERMIT � <br />. TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8f310 <br />G DEMOLITION ❑ COMBINATION �BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />UWNER MAILADOR SS � CITV ZIP PHONE <br />��.ar-/i�.4s�a�►/� /n�. Fl�$x 31v9 �rr,��a� 9�'4l0 3�-/oa� <br />nuui—t �� uen enn�cc.c CIiV T 21P PHONE <br />f be do,�a�s-n�� <br />�'CONT ACTPRICEOFWORK <br />/, 4�,a� ��n <br />��o�r� A���25 E5� <br />�/��G�1 s,<� .S�o� <br />5'Liad �2, 3/� 9�')` <br />PROPO DUSEOFBUI G <br />�y�ia� P��'!, <br />LEGAL UEStR�TION OF%ROPER (SHOWN <br />LOT �� BL��� <br />in � ,v�i 5� <br />G'd/u5��7 %s c <br />PRRC�LTA%I.D.NUMBER_ � J.� <br />TYPE <br />WATER CLO: <br />BATHTUB <br />KITCHEN <br />CLOTHES <br />FLOOR DRAIN <br />BACKFLOW PI <br />ROOF DRAINS <br />CITY <br />cin <br />�¢� <br />ATTACH <br />OR ITEM <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSETBAG� <br />USEZONE LOTAREA <br />NPEOFLONST. , NO.OFSiORIES <br />LOAD <br />INTAKE BV <br />' <br />FIRE SPRINKLERS REO'D <br />FIFF ALP�S REO U <br />�� J <br />PLANS APP(I`OVED BY <br />JJ 'R <br />DATE <br />�� <br />FEE <br />$ <br />ZIP <br />ZIP ' PHONE <br />ZIP PMONE <br />��/y $y�TATE�NSE n <br />•- �C/ <br />STAiE LICENSE+ <br />STATE UCENSE A <br />��5- 3¢3¢ <br />Y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIiJED THIP� <br />APPLICATION AND KNOW THE SAME TO BE 1'RUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINAPICES GOVERNING THIS TYPE OF' <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR <br />NOT. THE GRANTING OF A PEflM1T DOES NOT PRESUM� 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />rntiTaer.Tnas uW t927 RCW AND 296200 WAC. <br />� <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUiiNING) <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN � _ <br />IO��S r� `- <br />SIDE SETBACK _ PLAN CME� S�SOI <br />_`��_ <br />JFCPNT HTE FEES <br />(�VcS � N� BUILDING �ou•70Aii•`�� <br />rcuv.xa wa�-x«pewc«wa' � -- <br />cnouv PLUMBIN� �p Ja �� s �% <br />OASEMe 17� - MECHANICAL <br />U YES i�NO <br />HEiG�Ir i7Ajwn ADDITIONAL PLAN CHECK <br />Q OTHER <br />STATE BUIL�ING SURCHARGE <br />CITY OF EVERETT PUBLIG WORKS <br />LOCALSALES <br />TAX CODEIS 3105 rorn� <br />FEE . <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE 5 <br />PECEIPT NO. <br />�D. (r o� /C�S�i <br />8 <br />a <br />tl <br />