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APPLICATIC�'1 FOR CONSTRUCT )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEAT � <br />BUILDING DEPARTMENT ING SY„TEM. J GAS J ELECTRIC J_ I <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL �.PCUMBING SIGN <br />Ol9NER fAAILADD��� . ����IiY �` �� r/�pNO�. ���� / <br />PaSs Pon,t <br />c <br />A�iCNiiECiO�iDES�GNEq Id411qDDqESS <br />GENERALCONTRAGTON M�IIpDDRE55 <br />MAII ADDR[SS <br />PLUMBINC <br />CONTq4CT PqILE OF WOFK <br />DESCRIBE W ORN AN� SOUAR[ FOOTAGE INVOLV[D <br />� . i <br />QiY <br />CITV <br />rROPoseo usE oF ovao�vc <br />�, m _ �.� <br />IEGRL pESCRIPTION OF PROPGFTV �SMOYIN 9ELOW OR ATTqCN i WO COPIESi <br />�or o�ocK oF <br />PARC[LTA%IO.NUMBER <br />CONSTRUCTION tOAN LEI <br />NUMBEi1 <br />TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BA?HTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />LOW PREVENTERS <br />DRAINS—RAINLEADERS <br />PERMIT <br />FOR OFFICE USE ONLY: <br />FRONTSET9ALK qEARSETpACN <br />USEZON[ LOTAREA <br />iVP[ Of CON51. NO O� Si0RIE5 <br />9Z[ Of BLDG FlRE SPPINKLERS RE00 <br />OCCUPANCY L04D FIRE IILARM RE00 <br />n[nSON <br />wmrc[or ri,nNsnnpnoveonv <br />D!T[ <br />ZiP PHONE <br />2�P PHONE <br />ZIP PMONE <br />zin <br />ZiV <br />CONT�Ct P[RSON AND PHONE NO <br />ol ) <br />PMONE <br />PHON <br />i�� <br />JIRIt LICtN^SL C <br />� � �,/ ' <br />SiAiE LICENSE � <br />SiATE IICENSE r <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYF'E OF <br />WORK WILL 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 ANV <br />OTHER STATE OP LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY iHE <br />OWNER OF THIS PROPERTY TO PERFORM T"G WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18/27�/C1� D 296.200 WAC. <br />Xf/6t���- 'o�i� �� C%C/.�/% <br />_ICN�iUf1f U�IE <br />NO. TYPE OF EOUIPMEN <br />A�C—A�HNDL3 UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. A1 <br />i CLOTHES DRVERS <br />VENTILATION FAN <br />RANGE HOOD <br />� WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BUF <br />� FIREPLACE INSERT <br />FiP11 <br />�� �C� <br />✓ <br />vncnrvt sire FEES <br />'. I YES � � NO BUILDING <br />Of.CiIDpNtv NOOfDII(4�',=P�15 <br />'�OJ� PLUMBING <br />BnSEMENT MECHANICAL <br />�- YES �. : NO <br />HEiGNi uMiTanON �ODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILUING SURCHARGE <br />CITY OF EVERETT pU�LIC WORNS <br />LOCALSALES <br />TAX COUEIS 3105 Torn� <br />FEE <br />SUBTOT�L 5 <br />PERMIT 5 <br />TOTAL FEE S <br />FEE R[CEIPTNO. <br />VALUATION FEE <br />_i <br />� <br />