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APPLICATIC .J FOR CONSTRUCI.ON PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM• ❑ GAS O ELECTRIC ❑ <br />BUILDING DEPARTMENT ' <br />259•8810 <br />DEMOLITION COMBINATION BUILDING �(MECHANICAL PLUMBING SIGN <br />OWNqq � � Q � MAII.ADORE55 ,,, GRV _ ZIP PHONE <br />TENANT <br />ARCHITECT OR DESIGNER <br />GENERALWNTRFCTOR <br />MECMANICALCONTRACTOF <br />PIUMBiNG CONTRACTOR <br />CLAS$ OF WOFN <br />!C NEW � � ADDITION <br />DESCRIBE WORK AND SOUARE <br />LEGAL DESCRIPTION OF PFOPE <br />LOT BLOCK <br />PIi0.1ECTAr,ORESS <br />IAAIL AOOFE55 <br />MAIL ADDRESS <br />ALTERATION <br />WFTER CLOSET (TOILET) <br />BATHTUB <br />lA\.1TORY (WASH BASIN) <br />SHOWER <br />K�TCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />OF <br />OR ITEM <br />CITV ZIP <br />CITV IIP <br />CITV ZIP <br />CITV ZIP <br />REPAIR DEMOLITION � <br />� WNTACTy�P <br />FEE <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR SETOACK <br />lISEZONE LOTAREA <br />7VCEOFWN75.ALLOWADLE 7YPE0(GONS7ACiIlAL <br />SIZE OF BLDG. NOAF STORIES <br />OCCUPANCY LOAD F'RE SPRNKLERS REO'D <br />REASON FOR SPRINKLEFS <br />INTFKEBV PLANSAPPRObEDBV <br />SI�E SETBACH <br />' �� <br />PNONE <br />PHONE <br />PHONE <br />PHONE <br />PNONE <br />WOODSTOVE/FRPL INSERT <br />AND 990NE N0. i <br />STATE IICENSE M <br />STATE LICENSE a <br />STATE LICENS[ R <br />BUILDING RELOCATION <br />i HEREBY 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 WIL� BE COMPLETED WITH WHETHER SPECIFIED 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 I.00AL LAW REGULATING CONSTRUCTION CR 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 />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X ��_�{Cti ) 9�Z �/� � <br />sicNnimm on� � <br />TYPE OF EDUIPMENT FEE <br />AiC—NHNDLG UNITS—H.P. ; <br />FORCED AIR SYSTEMS—B.T.U. M E.P. � <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS <br />VENTILATION FAY � <br />RANGEHOOD <br />WATER HEATER � <br />WOOD STOVE ; <br />METAL FIREPLACE 8 CHIMNEY � <br />FIREPLACE INSERT � / Q ; — <br />HEAT PUA1P � <br />GAS PIPING <br />EXHAUSTFAN � <br />BUILDING <br />OLLIIP>NLY NOOfDWELL�NLU'Ii15 <br />cAoue � pWMBING <br />BrSEMENT MECHANICAL <br />HEiGH7unnTnnON ADDITIONALPLANCHECK <br />SPRINKLER <br />STAT[ BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUE IS 3105 T�TAL <br />FEE <br />SUB TOTAL $ j 2 1 U,- <br />PERMIT S 1�: — <br />n <br />� <br />; <br />