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I�,PPLICATIOP` FOR CONSTRUCTY�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />259-8810 <br />i DEMOLITION I_] COMBINATION x BUILf.: ' f 7 MECHANICAL IJ PLUMBING I SIGN <br />WNER �- <br />MA�L ADDR�55 <br />.Ia����._�. . . '"—_ _ CITV ZIP ounuc <br />��• <br />PROPOSED USE OF BUIL�ING ��R <br />LEGAL DE/S�C�f�iIPTION OF PROPEFN (SHOWN BELOW O'jR,� <br />LOT—(�eL._ � OF -� <br />PAFCEL TAX ID. NUMBEfl ���/�. �^ D� . <br />�%/ <br />LENDER <br />�t� <br />OR <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—RAR FTr: 1 <br />FOR OFFICE USE ONLY: <br />FPONTSETBACK fiFARSETBACK <br />USE ZONE�` LOT AR/EA 1 <br />-s z � <br />7YPEOFCONSi. NOAFSTORIES <br />REASON <br />il�% <br />INTAKE BV <br />SI;B TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />2 <br />FIRE SPPINKlERS PEO'D <br />N� <br />=1RE ALARM REO'D <br />�.iu <br />DqTE <br />BY <br />SIDE SETBACK <br />�7 � � <br />CONTACT PERSON AN� PHONE N0. <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 L1WS AND ORDINANCES GOVEqNING THIS TYPE OF <br />WORK WILL BE CCMPLETED WITH WH[THEFi SPECIFIED HEREIN OR <br />�IOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <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 WIT�' THE STATE <br />CONTRACTORS LAW 1627 RCW AND 296200 WAC. <br />scr�aru c _/r �� <br />wre <br />CRY BUSINESS OCEN$[ NO. - <br />MECHANICAL <br />NO. TYPE OFE�UIPMENT FEE <br />A/C—A/HNDLG 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 />D WOOD STOVE — <br />METAL FIREPLACE (Mi9BB.Bl�F11MqG —;�—` <br />O FIREPLACE INSERT � <br />HEAT PUMP , — <br />GAS PIPING � <br />��f EXHAUSTFAN . <br />PLAN <br />❑ YES ; NO BUILDING <br />occuvnxcv va oroviEuirvc�xns � � ' <br />Ao� <br />; PLUMBIMG <br />BASEMENT � � MECHANICAL <br />❑ YES �!?NO _ <br />HE:GHT LIMITATIOry ADDITIONAL PLAN CHECK <br />/ <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SU8 TOTAL <br />PERMIT <br />(l a� �; <br />FEE <br />�o2Z. <br />5 <br />8 <br />� <br />; � ' <br />'d <br />� '� <br />� <br />; a� <br />