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� APP�ICATIC�I FOR CONSTRUCT��N PERMIT <br />�N�� TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />��..�.. <br />BUILDING DEPARTMEN��� � <br />259-A810 <br />DEMOLITION ���xCOMBINATION <br />OWNER / MAILADDRESS <br />ARCHITECT <br />M�IL ADORESS <br />riEATING SYSTEM: U GAS � ELECTRIC ❑ <br />BUILDING MECHANICAL 1 PLUMBING SIGN <br />� rnunt <br />9 82v1 39,8-3 <br />cin <br />GITY ZIP PHONE <br />�G�� �Ii141.IJ OR 97Z3i Zob- <br />GENERAL CO`ITRACTOR � MAIL AOURESS CI7Y ZIP PNONE STATE LICENSE • <br />/� . t��� ., ;;,. <br />C]Gl��'r_..liill� l';� �� r;',=:j l> i'U � (� l I-����>Mil .:; f? ''� ;� <br />MECHANICAICONTRACTOd MARpDORESS dTY LP` PNONE STATELICENSE• <br />i��1r. � �iu�,;';���-T <br />PIUMBI.VGCCNTR�CTOR MAILADDRESS CITV 21P PHONE STATELICENSE� \7/I`,/ '/ <br />/ �T <br />CUSS OF WORK <br />'. ' NEW .�I ADDITION I�LTERATION �, � REPAIR �� DEMOLITION ,�. WOODSTOVE/FRPL INSERT f' BUILOING RELOCATION <br />(J G�CC/ �C/ONTACT PERSON AND �MONE NO. <br />CONTFACT PRICE OF WOpN I/�iN �OH'Ai� �.( 20 6- 439-t� � <br />DESCRIBE WORK AND SppARE FOOTAGE INVOLVE� <br />LEGAI DESCpIPTION OF PROPE <br />LOT __ BLOCK <br />PRQIECT AD6R^E55 <br />C/ <br />; PLUMBIN6 <br />� NO. TYPE O! <br />WATER CLOSET <br />BATHTUB <br />KITCHEM SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTI <br />ROOF DRAINS—RAWL <br />FOR OFFICE USE ONLY: <br />FRONT SETBRCN REAR SETBACN <br />USE <br />SI2E GF BLDG. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LOW ORATfqCH FOl1R COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEq SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME T� GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TFiF <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />OR ITEM <br />NO. TYPE OF E�UIPMENT <br />NC--A/HNDLG UNITS--H.P. <br />FURCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEH00� <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIM�FY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />_ i <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAL FEE $ <br />SIOESETBALN P�{NCHECK <br />I L/ /� <br />I VACANTSITE F <br />• v" BUILDING <br />iVPEOfCONSTACTUAL otcuoavcr HoorDw[LVxGuhrts <br />�1-A , eAouo r-- p�UMBWG <br />..w� �y <br />NO.OFSroaiEs BnSEMEr+7 MECHANICAL <br />�i IVD <br />FIRE SPPNKLENS PEO'� HEIGHT UMIiFT{GN ADDITIONA� �LAH CHECK <br />� SPRINKLER <br />STATE BUILDING SURCHARGE <br />PLANS APPROVED �Y CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />/-, �/�> .1U TAX CODE IS 3105 rorn� <br />f $ <br />FEE $ <br />a <br />