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APPLIC4T10'�` FOR CONSTRUCTI�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ I <br />259•8810 <br />O DEMOLITION f_] COMBINATION [ 1 BUILDING ❑ MECHANICAL ❑ PLUMBING ! SIGN <br />OYMER MRILaDDRE55 . LITv 21P PHONE <br />f 2- <br />TENNNT / AA�ID~IS (/��i�i /��Lt � �//ryN� ��� /_��_ _—.� <br />ARCHITEC'ORDESIGNER MAILAppflE55 GTY 21P PNONE <br />G[NEH�LCONTRACTOR MI11Lp�ORE55 CITV ZIP PHON[ STATELICENSEa <br />OW h er <br />MECNANICRLCONTRRCTOR MhILADDRE55 CITV ZIP PHONE STATEUGENSE� <br />CONTR�GT PRICE OF WORN <br />MFIL r10DPE55 <br />INVOLVED <br />LEGRL DESCRIPTION OF PROPERTY �SNOWN BELOW OR RTTACH TWO LOPIES� <br />LOT BLOCK — OF <br />PARCELTR%ID.NUMBER <br />CONSTRUCTIONLOANLENDER.ADDRESS,TELEPNONE NUMBER <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REARSETBACN SIO[SETBaCK <br />USE ZONE <br />7YPEOFLONST <br />512E OF BLDG. <br />IOTAREA <br />FIqE SPRINKLERS RE00 <br />OCGUPr1Nf,VLOAD � FlRERLAPMREOD <br />REASON <br />INTAHEBV I PLANSAPPROVEDBY <br />D�TE <br />CITY ZIP <br />VAGINiSRE <br />�- YES C NO <br />acweucv xo a ownuxcuvrts <br />L900P <br />BASEMENT <br />i ��, YES i_1 NO <br />HEIGIIT UMITqTIDN <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />CON7ACT PERSON ANO PNONE NO. <br />PNONE STATEUCENSE� <br />I HERCBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PPOVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TYPE 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 ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STAT[ <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />o.*c <br />TYPE OF EOUIPMENT <br />A/C—AMNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACf: IWOOD BURNING) <br />NUMBEj17 <br />�� ,. <br />BUILDItJG <br />PLUMBING _ <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PU�LIC WORKS <br />TOTRL <br />FEE <br />FEE FECEIPTND. <br />VALUATION FEE <br />� L� � j - <br />i <br />� `l 1 <br />JJ <br />l 9 ; st� <br />