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APPLICATIO �: FOR CONSTRUCT���N PERMIT � <br />TO BE COMPLE?ED IN BLACK INK—PLEASE PRIN� <br />HEATING SYSTEM: �1 GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259-8810 <br />I_J DEMOLIT70N i I COMBINATION BUILDING i MECHANICAL ', PLUMBING i SIGN <br />OWNER NAILApDnESS Cltt 21P PHONE <br />�L4�,� -a�ap.� `�5 W �i� �,? E�. �HZo3 z,SZ-G337 <br />TENPNT MPILADCRE55 CITV 21P PHONE <br />AFCNItECTOA�E5IGNER MAILApDRE55 CITV 21P PNONE <br />G[NERALCONTRACTOR MhILrtDDPE55 LITY ZIP PMONE liAtELIGENSE• <br />MAIL <br />PLUMBINGGONiRALTOR MAI! <br />,ONiRRCT PRICE OF WORH <br />�m0 U <br />OESCHIBE WORK AND S�UA'lE FOOTAGE INVOIV[D <br />PROPOSED USE OF U W LLING <br />LEGAL DESCRR i iON OF PR�P[RTY �SMGWN BELOW OR r1TTACM TWO CAPIES) <br />lOT - BLOCH OF <br />P�FCEL TNX I D. NtIMBER <br />IOPNLENDER. <br />T[LEPMONENUM�ER <br />ITEM <br />WATER CL .3ET (TC <br />BATHTUB <br />LAVATORY(WASHL <br />SHOWER <br />KITCHEN SINK 8 DI; <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—RAIN <br />FOR OFFICE USE ONLY: <br />�PONTSETBAGN REAR SEtOACK <br />iYPC OF CONSL <br />SIZE OF BL�G. <br />OCCUPANCVLOAO <br />REASON <br />INtAnEDY <br />lOT4FER <br />FlRE SPHINKLERS REOD <br />onre <br />)TAl 5 <br />r s <br />FEE $ <br />CITV IIP <br />iCJ .nr S <br />ZIP <br />�S3 �T�fY <br />CONTAGi PEPSON AN� PIIONE N0. <br />STAIC LIL[NSE � <br />S IFI [ Llli[N�t • <br />I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINPNCES GOVERNING THIS TYPE OF <br />WORN WILL BE COMPIETED WITH WHETHER SP[GFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PPOVISIONS O� ANV <br />OTHER Sli.'� Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE Oh CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWiJER OF THIS PROPERTV TO P[RfOFM THE WORK FOR WHICH <br />hPPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LhJJ 18.27 RCW AND 29G200 WF.C. <br />,c��,w.., � - 2 z-� <br />s�c�verunr n"�� <br />urr ausirv� ss uc�rvs� Ho <br />N0. I TYPE OF <br />A/C—AIHNDLG UNITS—H.P. <br />FORCEO AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />N'ATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP _ <br />GAS PIPING <br />EXHAUSTFAN <br />SIO[SETBACK P�/'+�rt�N <br />� <br />VAGANT EITE F <br />❑ YES -• NO BUILDING <br />acu��ucr n�ormm.uxcmn*s <br />�^d''v pWA1BiNG <br />BASEMEYT <br />'.=� VES �:-. NO <br />HEIGNT LIMITAiION <br />CITY OF EVERETT <br />LOCAL SALES <br />TA7( CODE IS 3105 <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PU�LIC WORKS <br />TOTAL <br />TOTAI S <br />NIT 5 <br />\L FEE $ <br />RECEIVTNO <br />� <br />� <br />