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APPLICATIC�'1 FOR CONSTRUCT' -1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: U GAS ❑ ELECTRIC �] � <br />259-8810 <br />)Q DEMOLITION f 7 COMBINATION CI BUILDING 17 MECHAt�ICAL f; PLUMBING ❑ SIGN <br />OWNEF , l.IAILAD�RE55 �ITV ZIP PHONE <br />J,Gt�, GASCJINr 7.20 GQ/��JU F}VE [verc�� yP�D� ,�52 8430 <br />TENANT MAIL FDORCSS <br />CITV ZIP PHONE <br />ARCNITECTORDESIGNER lAAILFDDFESS CITY ZIP PHONE <br />GENERALCONTRACTOfl MAIIFDDRE55 CITY ZI�' PHONE STATEUCENSEu <br />JG G�NSr �2� C�QI�NO AVE v�erc�� 9J'2� � 9�(3 Y5?D JCrcous.� <br />�33�(. <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITV ZIP PHONE STATE LICENSE p <br />PLUUBING CONTRqCTOR MAIL ADDRE55 CITV ZIP PHONE STATE LICENSE a <br />CONTqACT PFICE OF WORK <br />DESCflIBE WORN AND SOUARE FOOTAGE INVO WED <br />N <br />OF <br />CLEGAI DESCRIPf ION OF PROPERT�V �(SHO/�WN.�BELOW OR ATfACHLTWO CO�PIE�SI) <br />,<{mD� I � � BLOCH 1f711L'1L%�F �Y6�U� �/�1 L�i � <br />PAFCELTAXI.D.NUMBER <br />'{��3 - Dol - 0200 <br />CONSTRUCTION LOAN IENDER, ADDRESS. TELcPHONE NUTABER <br />� PLUMBING <br />. NO. TYPE OF FIXTURE OR ITEM FEE <br />_ WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH[R <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--RAINLEADERS � <br />SINK (SERVICE—R?ft, ETC.) � <br />SUB TOTAL S ' <br />PERMIT $ , <br />_ TOTAI FEE � 3 � <br />FOR OFFICE USE ONLY: <br />FflONT SETBACK qEAR SETBFCN <br />iYPEOFCONST. <br />SRE OF B�OG. <br />OCCUPANCYLOAD <br />REFSON <br />IDlTnKE BY <br />LOT AREA <br />NO.OF SiORIES <br />FIRE SPRINNLERS REO'� <br />PIRE �LAFiM REO'D <br />PLAl15 APPROVED BY <br />O�TE <br />0 <br />CONTACT PERSON AND PHONE N0. <br />i HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PqOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE 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 CANCEI THE PROVISIC'1JS OF ANY <br />OTHER SThTE OR LOCAL LAW REGULATIN� CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEflTY TO FERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOflS LAW 1827 RCW AND 296.200 N1AC. <br />Y�. d�s��rss ���E��sE No <br />MECHANICAL <br />10. � TYPE OF <br />g-r3-`/3 <br />POFCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />� WOODSTOVE <br />' METAL FIREPLACE � <br />� PIREPLACE INSERT <br />' HEAT PUMP <br />� GAS PIPING <br />T <br />EXHAUSTFAN <br />SIDE SETBAGK � PLqN <br />VAC4NT SITE FEES <br />❑ YES ❑ NO BUILDING <br />OCWPAHCY iAOFpYlFll11160Y115 <br />cnouv p�UMBING <br />BASEMENT MECHANICAL <br />S! YES G NO <br />NEIGNi LiMlia7ioN ADDIiIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />FEE <br />PERMIT S <br />TOTAL FEE S <br />REGEIPT NC. <br />FEE <br />� <br />