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APPLICATI�"'1 FOR CONSTRUCT"-1N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: �GAS J ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION ! COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OW��E� IdAIL�DDRE55 Q'v ZiP PHONE <br />�1�1j2�'/� v�a� �ri, diEwll��li �3Zd.7 � - s�oz � <br />LENI+4t MAILPO�RE55 CITY LP PHONE <br />ARCHi1ECTOR�E5IGNER MAiLP�DFE55 CITv LP PNONE <br />GE��ERALWNTRI.CTOF MAILADDRE55 <br />U[CMANICAICONTPACTOR MA�LADOPE55 <br />IAAIL ADDRES$ <br />CONTPACi FPiCE O� WORN <br />�% SDo � <br />INVOLVED <br />rnoPoseo use oF euaowc <br />LEG4L DESLFIPTION OF �'RpPERTV ISNOWN BELOW OR ATTACN TWO COPIES� <br />lOt JLOCN OF <br />PANCELTA%ID.NUMBEB <br />CONSTRUCTION LOAN IENDER. AODRESS. <br />OF <br />WATER <br />LAVATORYIWASH BASW) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />ROOF <br />SMK� <br />FOR OFFICE USE ONLY: <br />FRONTSETBNGN RE�R; <br />ITEM <br />SUBTOTAL $ <br />PERMIT 5 <br />TOTALFEE $ <br />US[ZONE LOTAREA <br />iYP[ OF CONSt NO. OF STGAIES <br />S2E OF BLDG. FIRE SPRINKLERS REO'D <br />OCCUPANLY LOAD FlR[ /L�RM REO�O <br />REFSON <br />INtI.KEBV PLANSAPPPOVE�BV <br />DFT[ <br />ciDE SETBACN <br />GTY 21P I <br />cirv zia <br />rU.�z�v�? C-Y �'fS�/ <br />GITY Z�P <br />� CONiAC� �'ERSON AND PNONE NO <br />STATE LIGENSE • <br />SiATE IICENSE • <br />Pr10NE STAIELiCENS[e <br />i HEREBY CER�(IFY THA7 I HAVE READ AND EXAMINED 1HIS <br />APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK JJILI 8E COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIGNS OF ANY <br />OTHER STA iE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORASANCE OF CONSTRUCTION. THAT I AM AUTHOR2ED BY THE <br />OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOR WHICH <br />APPLICATION IS MADe AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x � � % -�� 8-�Y - <br />9G VRI �G1E <br />C�lVt1JSWL55litly`u •o �� <br />Np, TYPE OF E�UIPMENT <br />A�C—AMNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.0 ��A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VEN7ILATIUN fAN <br />RANGE I100D _ <br />WAiER HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACFINSERT <br />i— <br />H[AT PUMP <br />GAS PIPING <br />� EXHAUSTf-AN <br />PLANGHECKNUMP-7[R I fE[ <br />UIOI/IO <br />VALANT SITE ��c� <br />-. YES . . NO BU�LDiNG <br />eccu�ixa �i,+a�nv:�c•,:�i�.'s <br />�0�'° PWMBING <br />BnSEMENT MECHANICAL <br />YES NO — <br />HEiGH7uMlintlOr+ ADOITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SU�CHPRGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COOEIS 3105 1�TAL <br />FE[ <br />0 <br />