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APPLICATIC ' 1 FOR CONSTRUCT'"�N PERMIT � <br />TO BE COMPLETEC IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: bJ GAS U ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />p�15q . _ . / MAILA �SS . /i . .CITY�.' _... /J�P � P�E /7�,.- • -..25<� <br />!3R-oc�wAl�Av�i��s �vz1�. �•�/gl,G�6/� l�d� �J�.R�Q,G998zo/ 2�5z-6��5 <br />APCHITECTORDESIGN R MAILAODRE55 CITY ZI PHONE <br />GENERALCONTRRCTOA MAILADORESS CITY ZIP PHONE STATEUCENSE• <br />MECHANICALCONTPACTOR MAILADDRESS CITY ZIP Pt.ONE STATEUCENSE� <br />CONTRACT PRICE OF WORK ���'O^' <br />V <br />;I�� ZIP PHONE STATE V1:ENSE /,�—��G <br />P <br />CONTACT PERSON ANU PHONE N0. /�R�/ ^�n ��, / <br />(% (l� �air t� /�� <br />�,� � P %2Hc1 l% � a� - 2-L� <br />"�"�'� J�� � 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PRO�OSEO USEOFBUILOING ��cT �j,'�.G�, (/ j� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />' PflOVISIONS Of" LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />LEGpLDE �I�ONOFPROPERTV�SHOWNBELOW0P4ACHTW0�1� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�or27 � BLOCN aF � - AUTHORITY'O VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />����� OTHER STATE OR LOCAL LAW PEGULATING CONSTRUCTION Ofl 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 C MPLY WITH THE STATE <br />PARCEL TAX ID. NUMBER ,..� /� O��7 M^O CONTRACTORS LAW 1827 RCW AND 2OO WAC. <br />`I�I3/-6L(o ! --�jl.C./ <br />CONSTRUCTION LOAN LENDER. ADDFjES�G. TELEPHONE NUMBER , � // � G , � � �� � <br />flXTURE OR REM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSE7BACK FEARSETBACK <br />USEZONE LOTAREA <br />iVPE OF CONSi. <br />OCCUPANCYLOAD <br />REASCN <br />INTANE BY <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE 5 <br />NO OF SiORIFS <br />FIPE SPRINKLERS REO'D <br />PLANS APPROVEO OY <br />onT��?i a� <br />MECNANICAL ' <br />10. TYPE OF E�UIPMENT <br />P.�'C—NHNDLG UNITS—H.P. <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 BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />VACANi SITE YhtJ <br />G YES ❑ NO BUILDING <br />I'�'f.pPANCY NO M N4FllING11Nrt5 <br />°nq1P PLUMBING <br />BASEMEnI MECHANICAL <br />❑ YES C NO <br />HEI�NTUMRATION ADDI710NALFLANCHECK <br />OTHER <br />STATE BUILDING SUHCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 TOTAI <br />SUB TOTAL S ' <br />PERMIT S <br />TOTALFEE S ' <br />FEE RECEIPTNO. <br />U <br />J <br />