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APPLICATIQ'1 FOR CONSTRUCT`lN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: � GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL f � PLUMBING I 1 SIGN <br />��n, Z�p PHONE <br />MAIL AOGRESS/ �^ <br />/wNEF .n � . . ul � � _ _I � 1 .. . I ("�.. , «� � a . l_ �fJf� �,� l� �� I <br />CRY � Z�P <br />GITY 1�P �. PHONE <br />GENERAL GONTflACTOR MFR ADDRE55 , CI ZIP PNONE STATL LICEYSE t <br />MEGNANICALCINJTRACTOR MAILADDRESS <br />CITY 21P PHONE STATE LILENSE • <br />PLUMBINGCONTPACTOR MRILADORESS CITY ZIP PMONE STATELICENSEM <br />CONTRALT PRICE OF WORK <br />UESCRIBE WORN AND SOUARE FOOTpGE INVOLVED <br />PROPOSED USE OF BUILOING <br />LEGAL DESCRIP110N OF PROPERTY ISNOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOGN OF <br />PARGELTA%I.D.NUMBER <br />CONSTRUCTIONLOANLEN�ER, <br />Sl'-FI � -�+_ <br />BATHTUB <br />KITCHEN SINK & DISP <br />TRAY <br />FLOOR DRA <br />BACKFLOW <br />ROOF DRAII <br />SINK 1SERV <br />ITEM <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />i-dONiSETBAGN REARSET9ACK SI�E <br />USE ZONE LOT AFEA <br />7VPE Of CONSi. NO OF STORIES <br />ene ne ai nf. iIRE SPRINKLEPS REO'D <br />OCCUPANCYLOAD <br />REACON <br />REOD <br />PLANS APPROVED 8'! <br />D4TE <br />FEE <br />CONTPGT PEPSON AND PHONE NO. <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 />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 CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUTATING 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 WITH THE STATE <br />CONTRACTORS LAW 18.27 R)CW A�1D 296200 WA� <br />/ / <br />/ -Ltf�'vl�L- �Z _C� ��� <br />S�GsnIDr�E ' Oet[ <br />NO. I TVPE OF <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />I IIJIT HFATFRS—B.T.U. M <br />VENTiLATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE ' <br />METAL FIREPLACE (WOOD BURNING) I <br />FIREPIACE INSERT ' <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />TOTAL <br />S <br />TOTAL <br />P�pNCHECKNUlAOER FEE I RECEIPT <br />yqGANT SITL rc�a <br />L_ YES � NO BUILDING <br />acuP+Nn no or ovrtu�ucu'��rs <br />�°a" PLUMBING <br />BASEMENT MECHANICAL <br />���� YES ❑ NO <br />HEIGHTLIMITATiON ADDITIONAIPLAt1CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY Of EVERETT PUBLIC WORKS <br />LOCAL SRLES <br />TAX CODEIS 3105 TOTAL <br />n <br />� <br />d <br />� <br />� <br />/ <br />