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APPLICATIC 7 FOR CONSTRUCT �')N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � <br />259-8810 <br />HEATING SYSTEM: iS�GAS .J ELECTRIC J <br />DEMOLITION ', 1 COMBINATION i 1 BUILDING �( MECHANICAL I � PLUMBING � SIGN <br />RNER MAttA00RE55 CiIY ZiP PHONE <br />� ee�,-r-�c K 4•� ,-�,-. s Gc� �������/ g s,�a�3 o?S� -�id � <br />TEN�NT AIAILADORE55 CiTV 21P � PHONE <br />ARCH�TECT OR DESIGNER h1AIL ADDRE55 CITV ZIP PHONE <br />GENERAICONTRRCTOR MldLADDRESS CITY IIP PHONE STAiEUCENSEt <br />MECHANICALCONiFAGTOR `AINLADD\RESS CITY ZIP PMONE STATELICENSE• y� <br />�\CJY1� �nUh C\ `F�Y�(] � I d <br />PWMBINGCONTRAGTOR MAILADDFE55 CITY 21P PHONE STFTEUCENSE/ <br />PRICE OF WOFN � <br />� <br />v09K RNO SOUFRE FO <br />♦ <br />�As o�.a . _�� <br />.�Q�1� \��S'4� <br />�POSED SEOFBUI�DING <br />"— \ �\C � <br />LEGAL DESCRIPTION OF PPOPEPTY �SMOWN BELOW OR ATiACH TlYO COPIES� <br />ior e�ocK oF <br />���o� �� <br />PARCEL TAX I D NUAIOER <br />CONSTROCiION LOAN LEI <br />TRAY <br />- OSX ' �= <br />DDRESS,TELEPHONENL <br />y-`��. <br />� FIXTURE OR ITEM <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSEi9AGY. PEPRSEiDACN <br />USE20NE LOTAREA <br />1VPEOfW1l9. NOOFSiORIES <br />52EOFOLOG. FIfiESPPINRLERSREOD <br />OCCUPANCYLOAD FIREALAFMNE00 <br />DY <br />OATE <br />APPPOVEDBY <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES (iUVERNING THIS TVPE 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 �F ANY <br />OTHER STATE OR I.00AL lAW REGULATING CONSTRUCTION Ofi THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 61' THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />FORCED AIR SYSTE <br />UNIT HEATERS—B.T <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER 7 <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESET�ACK PLANCNELNNIIM�ER <br />VALANT SITE FEES <br />. � YES _' NO BUILDING <br />OLN��4Yv NO 0� �1ILLu;u uM�S <br />wouv PLUMBING <br />BASEM[Ni MECHANICAL <br />.-�. YES - NO <br />NEiG11T UMRa90N ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCMARGE <br />CITY OF EVERETT PUBIIC WOFKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />NO <br />0 <br />8 <br />0 <br />