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APPLICATIO FOR CONSTRUCT[ N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM� J GAS J ELECTRIC J -� <br />BUILDING DEPARTMENT <br />259-8810 �� I <br />DEMOLITION I I COMBINATION <br />01VNFR_ _ M4iL��A��55 <br />�RQ� ITEC�DESIGNFB <br />GENER4LGOqiRFCTOR <br />MECHANIGAICONiRAGtOR <br />MAIL AODR9SS <br />MAII. AOOqE55 <br />IdAIL ADDRESS <br />�� � <br />� <br />IdAll ADDRE55 <br />COfJiHACT PRIC[ OF \NOPK ��D� <br />DCSCRIBE WORN AND $OUAFE FOpiAGE INVOLYED <br />-- -• � <br />BUILDING MECHANICAL �PLUMBING SIGN <br />❑TY ZIP PHONE � � <br />7f`� �A��{I �1�. oZ�7�%-�i��,Z1 <br />� cirv Lp vHoue <br />i � � o�-,�r,�rG �1'u� " ��%i <br />� QiY 21P PMONE <br />CITV 21P � PHONE S1A7ELICENS[a <br />C�iv 2iP PNON[ STATELILENSE+ <br />�� <br />CIiY ZIP PMONE STATE UC[ SE � <br />l(Ol l�. Y�2T / iLD �1ZP,u�� �-`I�� <br />�qOV'OSED USE OF 6UP.OING <br />2 <br />L[ WL �ESGRIPiION CF PRCPEfii V ISNOWN 6ELOW OR ATTACH i1Y0 GOPIES) <br />lOT BLCCH OF <br />PARCELTA%ID.NUMOCH <br />LONSTRUGiIONLOAN�EN�ER.A�ORE55. <br />ITEM <br />CLOSET <br />SHOWER <br />KITCHEN SINK 8 DISP <br />URINAL <br />DRINHING FOL <br />FLOOR DRAIN <br />BACKFLOW PF <br />R�OF DRAINS <br />SINK (SERVICI <br />FOR OFFICE USE ONLY: <br />PHONiSETOFCK REARSETd�CK <br />USE20NE LOTAREA <br />hTEO�CON51. NO.OFSTOqIES <br />Si2[OF�LDG. FIP[SPFINNLERSREnD <br />OCCUP�NCV LOAD FIRE AI�RM REOD <br />Rf-ASON <br />irilnvf [lv PLANSAPPROVEDDY <br />D/iE <br />FEE <br />CONiAGT PERSON AND PMONE ND <br />DB ���'//l/� o����//� <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINC-D THIS <br />APPLICATION AND KNOV� THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL OE COMPLETED WITH WHETHER SPECIFIED FIEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF GONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW�W ANO 296.200 WAC. <br />"'' � i Gl�ri aS� f Y <br />yf.NetuNE �elE <br />TYPE OF EOUIPMENT FEE <br />A'C—A�HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN � <br />— ----f <br />RANGEHOOD <br />WATEH HEATER _ <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT FUMP <br />GAS PIPING <br />EXHAUSTFAN _ <br />SIOESETBACN �L�NCNtcrcNUmec�� <br />� � <br />vncnNr SiTE FEES <br />� YES � � NO gUi�DiNG <br />nrn,vnvcv ��ao�owuwuc���s <br />cem�v pLllPdBllw <br />BASEMENT MECHANICAL <br />�—'�, YES - - NO <br />HE�G�iTIIMITnT10N ADDIiIONALPLANCHECN <br />07HER <br />STA1E OUILDING SURCHARGE <br />CITY OF EVERETT PUBUC WORKS <br />LOCRL SALES <br />TAX COUE IS 3105 TOTAL <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />FEE � RLCEIPT <br />T <br />R <br />B <br />0 <br />