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APPLICATIQ"' FOR CONSTRUCT►"�N PERIVIIT � <br />�/� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />j/ � <br />HEATING SYSTEM: ❑ GAS I� ELECTRIC ❑_ � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION 7 COMBINATION <br />nwu�o MAIL�ODRE55 <br />ARCHITECTOflDE51GNER MAILADDFE55 <br />p T ,�. ,�s.�,w� s. <br />. moe�a MAILPDDR2SS <br />MECHFNICALCONTRACTOR MAILAOORESS <br />MAIL ADDRESS <br />CONTRACT PRICE OF WORN <br />DESCRIBE WORN AND SOUPRE <br />PROPOSED USE OF BUILDING <br />LEGAL OESCPIPTION OF PROPEFTV (SHOWN 9EL01 <br />� <br />LOT BLOCK OF <br />T�%% NUMBER� /� ��— <br />l V C.L <br />UCTION IAAN LENUER. AD�RE55, iftEPHONE <br />PROJ�CT� / �SS � � `A �� <br />f L.� j// <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />f WATER CLOSET (TOILET) <br />� SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAV�JDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: , ��� <br />FRONTSETBAGK / REARSETOACK/ <br />/ <br />USEZONE LOTAREA <br />TVPEOFCONS� NO.OF ORIES <br />SIZEOFBIOG. FIqESPRINNLERSREO'D <br />OCCUPANCV LOAD FIRE A <br />a <br />REASON <br />INTAKE BY P�AN <br />onrE <br />;1� BUILDING <br />CITY <br />*'� >� ���Q <br />QTY <br />CITY <br />FEE <br />0 <br />❑ MECHANICAL <br />ZIP PHONE <br />sSlZ6/ 3�9 <br />ZIP PHONE <br />I�p PHONE <br />�QZio x�'7s' <br />ZI f HONE <br />ZIP PHONE <br />ZIP PHONE <br />CONfACT PERSON AND PHONE N0. <br />�1 PLUMBING ❑ SIGN <br />57A1E LICENSE Y <br />STATE UGENSE q <br />STATE LICENSF'� <br />�3- <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CONRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOfiK 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 REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COidPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x �-- ,C �-� �-Zs-r4 _ <br />SGNALIIRE DniE <br />cirr ousi�+ess ucer+se r+o. <br />MECHANICAL <br />JO. TYPE OF E�UIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. _.�_ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFYEflS ' <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 />� EXHAUSTFAN _ <br />.S 121v uv� <br />l PLAN� <br />V.CPNT SITE YCCA <br />L' YES ❑ NO BUILDING <br />accuvaucr na o�oweuineuuns <br />fy°°,3 I PLUMBING <br />1� <br />BaSEME�+i _� MECHANICAL <br />� YES !� NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />_ i <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBI.IC WOHKS <br />LOCAL SALES <br />iTAX COUE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT T� <br />TOTAL FEE 5 <br />