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APPLICA'T10 FOR CONSTRUCT �1� PERIVII'T <br />TO E1E COMPIETED IN BLACK INK—PLEASE PRINT `�M���T <br />HEATING SYSTEM: !J GAS U ELECTRIC J_ —� <br />BUILDING DEPAI;TMENT <br />259-8810 <br />! '� DEMOLII'10 ' 1 COMBINATION <br />qlN�,![R MAILADDFESS <br />V`�%R�i�E$ obRit�c� <br />+�.innir A LADURE55 <br />� ! BUILDING <br />CITY <br />�5��� 1��1 <br />CITY <br />MECHANICAL <br />zir � � PHONE <br />Z��Q <br />PLUMBING SIGN <br />_�,y� -5� q�. <br />ARGHITEGTORDESICNEfi ��AILADDRE55 CRV ZIP PHONE <br />ERALCONTRFCTOR 6��ILAODfiE55 GITY ZIP P110flE STATELICENSEa <br />�'�N�.A <br />A1ECH4NICP�CONTHACTOR l.7MLADDRESS CITY ZIP PMONF STATELICENSEa <br />PWMBINGCONTRACTOR IAAILAOORE55 <br />�NTRAGT PRICE OF <br />� . 00 ( <br />oescaioe woaK nNo <br />�� <br />S <br />GITY ��P <br />�:� <br />PHONE STATE LICENSE a <br />np� `�,�,,,,,,,��a (�...�J.�y-�t� ' i HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br />PFOPOSED 115E OF gOIL�ING � \ APPLICATION AND KNCW THE SAME TO BE (RUE AND CORRECT. ALL <br />�C� v PROVISIONS OF LAWS AND ORDINANCES GOVC-RNIN� THIS TYPE OF <br />�ecnio�FIP7IGNOFPRCPE(iTY�SHJE ala"?� ��.,n ^CNTµ'�c�r1es� WORK WILL BE CO�APLETED WITH WHETHER SPECI�-IED HEREIN GR <br />n � � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�or eiocK AUTHORITY TO VIOLATE OR CANCEL THE PROVISICNS OF AN� <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOFlA1ANCE OF CCDlSI"RUCiION. THAT I AM AUTHORIZED BY THE <br />GWNER OF THIS PROPERTY 1'0 PERFORM THE WORK FOR WHICH <br />�PPLICATION IS MADE AIJD I COMPLY WITH THE STATE <br />PARCEL TA%ID. NlIh19ER CONTRACTORS LAW J82�RCW AND 296.200 W.4C. <br />GONSTFUCTION LOFN LENDEF. AODRE55. TELEPMONE NUTABER <br />PRO�!ECf ADDRES� �� n � <br />TYPE OF FIXTURE OR IT <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LPVATORY(WASH BASIN) <br />SHOWER <br />K!TCHcN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK flEAR SETBACK SIDE <br />USE ZONE <br />TYPE a: CONST <br />SRE OF BLDG. <br />OCCUPhNCYLOnD <br />REASON <br />INT�KE BY <br />LOT AREA <br />FIRE SPRINNLE�S FEOD <br />FIqE AI �Pld REO-fJ <br />PLpN$ APPFOVED BY <br />�� <br />onre i� /, /o - <br />� <br />Y <br />q <br />e <br />V J <br />NO. TYPE OF EQUIPMENI <br />ArG—ArtifdDLG UNI (S—Ii.P. <br />FORCEDl.�RSYSTEMS—BJ.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 PUIdP <br />GAS PIPING <br />I EXHAUST FAN <br />PLANCHEGN��/R % I FEE <br />L.�' �� <br />vncnNr siTe reea <br />, YES : NO BUILDING <br />ouuo;,�,cv �oc�o:��u�urms <br />cacu= PLUMBING <br />BASEIAENT MECHANIC4L <br />�,'-; YES '� NO <br />��EiGnT ur.�ITnTioN ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SU�CHARGE <br />CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 T�TAL <br />FEE <br />SUB TOTAL � 5 ; U�' <br />PERMIT S <br />TOTAL FFE S �`�" ' � <br />RECEIPT NO <br />VALUATION FEE <br />� � � vv <br />�- <br />/�' �� <br />�N <br />O <br />�, <br />