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APPLICATIO", FOR CONSTRUCT�"_ N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: � GAS ❑ ELE(;TRIC ❑ � <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION C J BUILDING �MECHANICAL J PLUMBING ❑ SIGN <br />pWNER MAIL ADDRE55 CITV ZIP PNONE <br />��i�t�l No u ��vS �icr�L� �-I lz�_`� <br />TENANT - 1 MAIL AD RE55 CITY ZIP PHONE <br />$��- -&.N--i"���� � � cnD � I (� � � �,T <br />ARCHITECTORDESIGNER MAILAD� Ea5 --�� Z�P PMONE <br />GENERAL f.ONTFACTOR , � MAIL pDORE55 CITY _ � _ZIP _` ^ `MONE _ ` STATE UCENSE' / _ , r / <br />MECHANICAL GOHTRACTOB MAIL AU RESS CIiV � 21P PHONE S"fATE LICENSE R <br />PLUMBIN3 CONiFACTOR MAIL AODRE55 qTV ZIP PMONE STATE UCENSE N <br />C.ONTRACTPRICEOFWORKj � _ _ <br />q� (T i <br />b 1__ <br />DESCFIBE WORKANDSOIIFRE FOOTAGE INVOLVED <br />PROPOSED USE bF BUILDING <br />LEGAL DESCR�FTION OF PROPERTY ISHOWN BELOW Ofl ATTACH TWO COPIES) <br />ior e�ocK -- oF <br />PARCELTA%I.D.NUMBER �� IC <br />CONSiRUCT10NLOANLENDER,AODRESS, <br />N0. T`IFE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />CLOTHES WA: <br />URINAL <br />DRINKING FOI <br />FLOOR DRAIN <br />SINK <br />FOR OFFICE USE UNLY: <br />FRO4TSE78ACK PEARSETBACK <br />USE20NE <br />lVPE OF CONST. <br />SIZE OF BLOG. <br />OCCUPANCYLOAD <br />REASON <br />INTAKE 91' <br />LOT AREA <br />NUMBER <br />J. <br />U <br />0 <br />9S ' <br />_. � <br />_ <br />— — � <br />SUB�iOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />SIDE SETBACK <br />FIRE SPRINKlEflS REQ'D <br />FIRE ALARM PE00 <br />DATE <br />ev <br />CONiACT PERSON FND PHONE NO. <br />I HEREBY CERTIFY THHT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND MNOW THE SAME TO BE TRUF AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT �OES 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 CONST CTION. TI1AT I HORIZED BY THE <br />OWNER OF THI P �O� THE 0 FOR WHICH <br />APPLICATI I E�fCND I�OMPLY E STATE <br />cirr ausirvess c �r.n+ <br />MECHANI L <br />NO. TYPE OF E�UIPMENT <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED Alfi SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />� FXHALIST FAN <br />VACANT SRE YC W <br />❑ YES !—' ND BUILDING <br />acuoancv r;oovowewxcuwrs <br />caoua PLUMBING <br />BnSEMENi MECHANICAL <br />C YES G NO — <br />HEIGHTUAIITATION AD�ITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL S.ALES <br />rer r.nnF ic a�n5 rorn� <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />//,�1,�(� <br />N <br />n <br />