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APPLICATIQ"1 FOR CONSTRUCTi'1N PERMIT �� <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATWG SYSTEM: iJ GAS :� ELECTRIC ❑ <br />259-8810 <br />X DEMOLITION f 1 COMBINATION L i BUILDING MECHANICAL I] PLUMBING I! SIGN <br />OWNEN MNL�DDRE55 QTV ZIP PHONE <br />_h;_�e.l��l Coad; �I 3�3� �Roe�L�E/��'rEJE►-� �.sn_��i i <br />IENANT 614IL ORE55 QTY ZIP PMONE <br />FFCHITECTOROESIGN'cP MAILADDRESS CITY 21P PHONE <br />GENER4LCONTRnCTOF MAIIADDRESS GTV ZIP PHONE STTELICENSE� �4�+ � <br />���� E�f�i �a,�sfl,�e . Sax �c y M� lfEo t� 3 z, <br />MECN�NIG�LCONTR�CTOR IdAILA0DRE55 CIfV ZIP PNONE STAiEUCEN r <br />PLUhIBING CONTRACTOR MAIL AOORESS CITV 21P PHONE ST(.TE LILENSE Y <br />CONiRACi FRICE OF WOiiH I . <br />DESCRIBE WOFK AN� SOU�RE FOOihGE INVOLVEO CONT4GT PERS01.1 �N�r+ E NO � <br />A F a1 e A�.rd d� '. ,✓ n YiA e �- J 1� w/ s f�t/ ��' �%� R'7 <br />PROPOSEO USE OF BUILDING <br />LEGAL DESCRIPTION OF PFJPERTY �SHOWN BELOW OR <br />IOT�— BLOCK � s�n OF F-4 <br />PAFCEL <br />PROJECT <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORI' (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />Di?�NKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEAC <br />SINK 1SERVICE-BAR, ETC <br />� <br />NUMBEF <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBFCN RE�R $ETt iCK <br />USE20NF LOiAREA <br />IYPEO�CONSL �OOFSTORIES <br />SIZEOFBLDG. FIRESPRINKLERSFEO'D <br />OCCUPANCV L04� ��RE ALAPM NEO D <br />RE�SON <br />INTAKEBY PLANS�PFROVE08� <br />DATE <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED 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 COMPiETED WITH WHETHER SFECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORh7ANCE 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 COMFLY WITH THE STATE <br />CONTRACTORS LAW 1827 FCW AND 296.200 WAC. <br />X (�!i 3/At�c, 9� <br />sicrvntwic —7 wre <br />CiLV PUSiNE55LtCENS[ NO <br />MECHANICAL <br />JO. TVPE OF EOUIPMENT FEE <br />A/C-A/HNDLG 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 />META� FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING ; <br />EXHAUSTFAN � <br />SIpESETBFCK PL4NCNECNNUMBFR <br />[-�L{53 <br />VACP.NT SITE FEES <br />: � YES . J NO BUILDING <br />IICCJPA�^,v :OO�pNElUNGO'dI5 <br />G90,v PLUMBING <br />BASEMEAT MECHANICAL <br />- YES ^ NO <br />HEIGHT LINIT�TION ADDITIONAL PLAN GHEGK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PU�LIC WOfiKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE 5 —~ <br />FECEIPT N0. <br />VALUATION FEE <br />i <br />� <br />i <br />i <br />i <br />� <br />