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APPLICAT10�1 FOR CONSTRUCT''1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEfl MRILApORESS CITV 21P PMONE <br />Mcl�or�ov�Crl� i�a.r,1 C 6y�4El�iei'�'l.�a.��e�l�"[� �i8�3 353-JS�Ff <br />TENRNT MRIL �RESS CITV ZIP PHONF. <br />ARCHITECTORDESIGNER MAILAODFE55 CITV 21P PHONE <br />GENERALCONTPALTOR MAILADORESS CITY ZIP PHONE STATELICENSEI <br />MECNANICAL CONTRACTOR MAIL AD�RE55 CITY ZIP PMONE STATE LICENSE r <br />PLUMBINGGONTRACTOR MAILAOORESS QTV ZIP PHONE STF7ELICENSE� <br />GONTRRCT PRICE OF WORK <br />�ESCRIBEWORNANUSOUAREf00TpGEINVOLVED CONiPLTPERSONANPPHONENO. � � <br />PFOPOSED U�E OF <br />IEGpL DESCRIPTION OF PROPEPTY �SHOWN BELOW OF ARACH TWO COPIES� <br />LOT � BLOCN � OF � �—�n� � <br />PRFCELTAXID.NUMBEP <br />CONSTRUCTION LOAN LENDER. ADDRE55. <br />NO. <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 />FOR OFFICE USE ONLY: <br />FRONiSETBALK REFR: <br />Z�' <br />USEZONE 7 LOTAi <br />� � V � <br />TVPE0ICONSi. NOAf <br />, <br />BLOG. FIRESPRINKLEFSflEO'D <br />SI1V <br />NCV LOAD FIFE ALAqM PF.00 <br />.I A � <br />i <br />3Y PI�N�RpVEDBV <br />� <br />6�' <br />�,. <br />onre �� /,. � /Q� <br />)TAL $ <br />f S <br />FEE S <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH�S <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI— 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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 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 18.27 RCW�Ni1,�9&E09�WAC. <br />iT / ' - / \ �EIE <br />� <br />NESS LIG "NSE NO. <br />pNICAL <br />TYPE OF EOUIPMENT <br />NC—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT NEATERS—B.T.U. M <br />CLOTHES DRYERS C� (c�'j <br />VENTILATION FAN <br />RANGEHOOD <br />WAtER HEATER " ch_ <br />WOOD STOVE ' <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL S <br />�1,t,�r <br />SIpE SETBACK PLAN CMECN NUMB[ FEE <br />5" �!5'7 a <br />VACANT SITE �� FEES <br />❑ YES /.� NO BUILDING <br />amv�xw uoaewuuvcuwts <br />BAS,�pou� I PLUMBING <br />EMENT � MECHANICAL <br />❑ VES L�'NO <br />HEIGHTLIIAITFTION ADDITIONALPLANCHECK <br />_� I <br />7� OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />�AX COUE IS 3105 rorn� <br />,i'%� l .( <br />6. 7I o <br />no <br />