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APPLICATI� FOR CONSTRUC'�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMEhT HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ � <br />259•8f110 <br />�J DEMOLITION L � COMBINATION ' BUILDING i I MECHANICAL �_ ! PLUMBING �' SIGN <br />OWNEfl MAILADDflE55 CITV zIP PHONE 5"' <br />\_ .. �. �Ir.n._a �_� ........ i„n„�i /i!,[!f+ C'1 A�C Bn/. �.�-- i.in ae_'_ �.i_— <br />! TENANTG��� MAILAO�� CITY ZIP PHONE / <br />i _ <br />�y ARCHRECTORDESIGNER MAILADDRESS CIT1' ZIP PHONE <br />k <br />� GENERALCONTflACTOR MAIIADDRESS CITY T.IP PHONE SIATEUCENSE� <br />F MEC�CA�O�Tfl�TOR M_AILAD%PES� CITV ZIP PHONE 5lATELICENSE+I <br />' '+' . � i`� 73 <br />PLUMBINGCONTRACTOR MAILADORE55 CIiY ZIP PHONE STATELICENSEI <br />a <br />4 <br />; CIASSOFWORK <br />❑ NEW �I 1 ADDITION I I ALTERA710N '� REPAIR .�. DEMOLITION i! WOODSTOVE/FRPL INSERT i! BUILDIN� RELOCATION <br />x I CONTACT PERSON AND PMONE NO. <br />PROPOSED USE OF BUILDING <br />Sf,e <br />LEGAL DESCRIPTION OF PROPEPi /(SHOWN BELOW OR ATTACH FOl1R <br />LOT BLOCK OF <br />ADDRESS <br />// d✓- • �+7' �iwi ia. <br />VLUMBING • <br />O. TYPE OF FUCTURE OR ITEM <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEFi <br />KITCHEN SINK 8 DISP <br />DIS:�iWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FEE <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACN <br />� USEZONE LOTAREA <br />TYPEOFCONTS.PLLOWABLE TYPEOFCONSTAGiUAL <br />SIZE OF BLUG. <br />FIRE SPRNKLERS REO'D <br />REASON FOR SPRINKLERS <br />BV I P�NSAPPROVE�BI' <br />SIDE SETOAC <br />VACANT SITE <br />6 <br />I HEREBY CERTIFY THAT I HAVE READ AND Ei(AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF � <br />WOflK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br />AUTHORI'fY 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 8Y THE � <br />OWNER OF THIS PFOPERTV TO PERFORM THE WORK FOR WHICH ' <br />APPLICATION IS MADE AND I COMPLY WITH THE SfATE � <br />CONTRACTORS LAW 18.27 RCW AND 2?6.200 WAC. . <br />x t� • l.oa-i�_L���✓ N�5 y" <br />S�cNniunE oA*E <br />cmeuswess ucsnse wo. � <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT fEE . <br />A/�A/HNULG 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 FIREPLACE & CHIMNEV � <br />FIREPLACE INSERT ; . <br />HEAT PUMP � <br />GAS PIPING ; � <br />EXHAUSTFAN � <br />BUILDING <br />OLCUVANGY NO f,ipNFIIINGUNIi$ � <br />�AO1v pLUM81NG <br />BaSErnErv7 MECHANICAL <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILUING SURCHAFiGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CQDEIS 3105 TOTAL <br />PERMIT $ � <br />TOTAL FEE � 3a ! � <br />FEE � RECEIPT <br />P <br />� <br />T � <br />1 <br />3a�o� <br />