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a <br />A <br />APPLICATIO.� FOR CONSTRUCTI JN PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �w� <br />HEATING SYSTEM: G GAS i] ELECTRIC �J <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLI'fION 17 COMBINATION � BUILDING i-; MECHANICAL Cl PLUMBING l SIGN <br />OWNER MAILADDFE55 CITV ZIP PHONE <br />ti�P r� Gc/ P,� ar.� s� i3 �5 �+ ��� �. �� 9�r-2 n l n y,� -1 � y✓� <br />TENANT <br />APCHITECT OR OESIGNER <br />PLUMBING <br />M iIL AD�RE55 <br />MAIL qDDRE55 <br />/XU - <br />DESCRIBL WORK AND SOUARE FOOTAGE INVOLVEO <br />PROPOSE7 USE OF BUILDIN <br />LEGAL DESCRIPTION OF PROPF <br />�or oiocK <br />OF <br />PARCELTA%I.O.NUMBER <br />CONSTRUCTION LOAN LENOER. ADDRESS. lELEPHONE NUMBER <br />PRWECTADDRESS „ <br />NO. TYPE OF FUITURE OH ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEVTERS <br />ROOF DRAINS—RA„JLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />TWO COPIES) <br />PERMIT 5 <br />TCTAL FEE $ <br />FOR aFFICE USE ONLY: <br />FPONTSETBACN PEARSETBACN <br />UBEZONE LOTAREA <br />TVPE Oi CONST hO.OF STORIES <br />SRE OF 9LOG. FIPE SPRMKLFRS REO'D <br />OCCUPANCYLOAD FIREALAFN.REO-D <br />REA;AN <br />INTAKEBY PLANSAPPRUVEDBY <br />DATE <br />CITY ZIP <br />GTY 21P <br />�c Ska��,,,, S£roZ9'D <br />CITV ZIP <br />CITY 21P <br />CONTACT FEFSON AND PHONE NO. <br />� <br />0 <br />PHONE <br />PHONE <br />FM7NE <br />STFiE LICENSE i <br />STATE LF` �'IC N LM <br />STAiE LICENSE t <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 GOVERNING THIS TYPE OF <br />WURK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NUT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR GAkCEL THE PROVISION;i OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWPIER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIvATION IS MADE ANU I COMPLY WITH THE STATE <br />CONTRACTORS I.AW 18.27 RCW AND 296200 WAG. <br />x-JL� _ /L�-// i3 <br />s�GHnrunE oAiE <br />�IiY Bp51NE55lICENSE NO <br />MECHANICAL <br />N0. TYPE OF E�UIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. � <br />FORCED AIR SVSTEMS—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 (WOOD BURNING) <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />G.aS PIPING I ; <br />SIDESETBACN PLANCMECKNUlABER <br />2 32 <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILOING <br />OCCuvn!�Cv xoC�UWE�UNCUNnS <br />eAouv PWMBING <br />BASEMENT MECHANICAL <br />�� YES '-! NO <br />HEiGMT uAa7AtioN ADDI710NAL PLAN CHECK <br />OTHER <br />STATE PUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOFiKS <br />LOCAL SALES — <br />TAX CODE IS 3105 rorn� <br />SUB TOTAL $ <br />PERMIT $ <br />RECEIPT AO. <br />0 <br />;�� <br />