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APPLICATIC� FOR CONSTRUCT`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: • GAS ❑ ELECTRIC ❑ <br />259-8810 <br />i] DEMOLITION ❑ COMBINATION ! I BUILDING �� MECHANICAL !:I PLUMBING ❑ SIGN <br />OWNER MAILADDRESS qTY 21P PMONE <br />G� �jEUI�% l.hGuc.'� Zoi3 tc�1�.clJ—s��l �Y `IS o� �3• •m�% <br />TENANt MAI�ADDRE55 QtY 21P PMONE <br />ARCHITECT OR DESIGNER MA1L RDORESS CITY ZIP PMONE <br />MAIL AODRESS <br />CITV ZIP <br />STr1TE LILENSE t <br />MECHANIGAL CONiR'.CiOR Mr11L AD�FE55 CITV ZIP PMONE STr1TE LIGENSE • <br />-�/ifu�7`�E�T%�%l i.�7 ' r.U��-BBii . 98a�/ �•33y�f S's9c�iNo�4oc <br />PLIIMBINGCONTRAGTOR MRILADDRESS CIiV ZIP PHONE STATEUCENSE� <br />CONTRACT PRICE OF WOqK <br />G� <br />DESGRIBE Y/ORK AND SOUAfiE FOOTRGE INVOLVED <br />PROPOSED USE <br />LE W L DESCRIPTION OP PROPERTV ISNOWN BELON OR ATTf.CH TWO COPIES� <br />LOT BIOGK OF <br />P�RCELTA%ID.NOMBER <br />CONS�RUCTIONLOANLENDER,ADDRESS.TELEPHONENUMBER <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />SHOWER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW FREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FflONT SEiBAGK REAR SETBACN <br />USE20NE <br />iYPE OF GONSI. <br />SIZE OF BLDG. <br />OCCUP�NCYLOAO <br />PEASON <br />INTAKE BY <br />LOTPRER <br />NO.OF STORIES <br />FlRE SPRINKLERS REO'D <br />FIRE ALARM REO'0 <br />PLANSAPPROVEDBY <br />DATE <br />FEE <br />SIDE SETBnCK <br />VRCANTSRE <br />G YES G NO <br />OCCUMH[Y HOpO'Mll�N6lM',i5 <br />bnCuv <br />�ASEMENT <br />L YES ❑ NO <br />HEIGHT LIMITRTION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />LONTRCT PERSC . <br />L� <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT �RESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEI THE ��iOVI510NS OF ANY <br />OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br />PeRFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRAG70RS LAW 18.27 RCW AND 296200 WAC. <br />NO. TYPE OF EG <br />N�NHNOLG UNITS- <br />FORCED AIR SYSTEM: <br />/ UNIT HEATERS—B.T.U. <br />WOODSTOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUS?FAN <br />PIAN CHECK NUMBER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />AD�ITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TO7Al <br />FEE <br />