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���� <br />APPLICATION F�R CONSTRUCT�ON PERMIT �✓�� <br />TO BE �.�IPLETED IN BLACK IMK—PLEASE PRlif i <br />BUILDING DEPARTMENT HEATING SYSTEM: - GAS ❑ ELECTRIC U <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL �PLUMBING ❑ SIGN <br />ENANT <br />ARCHITEC70R OESIGNE <br />GENEflALCONTRACTOR <br />CONTRACiOR <br />��' <br />� PFICE/ �O/F W'�ORK <br />�C V�/ <br />WORK AND $pUil <br />MAIL ADOFE55 <br />rl-.. A_ _� <br />MAIL ADDRESS <br />lAAIL <br />MAIL <br />PRQOP S D 115E OF BUILDIYG <br />LEGAL�CRIPTION OF PROPERTV (SHOWN BELOW OR ATfACH TWO COPIES) <br />wr o�xK oF <br />PAPCELTAXI.O.NUMBEfl <br />CONSTFUCTIONLOANLEN�ER,AOORESS.TELEPHONENUMBER <br />NO. TYPE OF FIXTURE OR I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />� DISIiWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEFS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEG $ <br />FOR OFFICE USE ONLY: <br />FRONT SETUACK FEAR ScT�ACK <br />USLZONE LOTAREA <br />IYPEOFLONSi. NO.OF STOflIES <br />SIZE OF OL�G. FIflE SPflINNLERS REQ'D <br />OCCIIPANCY LOFD FIRE ALARM REO'D <br />BY PLANSAPPRO�'EUOY <br />DATE <br />� 1� <br />QTV ZIP <br />CITV 21P <br />CITY ZIP <br />GIIY <br />QTV <br />FEE <br />� <br />PHONE <br />PHONL <br />PHONE <br />STATE LICENSE a <br />ZIP PHONE Si�TELICENSEM <br />ZIP PHONE STATE LIGENSE a <br />CONTACTPERSONANDPHONENO. � ^ n nnL ���_^ ��� <br />I.�XoVVN ��_ <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 />WORY, WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME 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 BY THE <br />OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY W�TH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�- � I a-31�3 <br />SiG iURE DAiE <br />LIiY OUSW ESS IICENSE N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT PEE <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 DRYERS � <br />VENTILATIUN FAN ' <br />RANGEHOOD � <br />L WATER HEATER <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT ; <br />HEAT PUMP � <br />GAS PIPING ' <br />EXHAUSTFAN � <br />PLANCHECKNUMBER I FEE <br />VACANT SITE FEES <br />❑ YES �.I NO BUILDING <br />OCCOPANCY NO.CfCW(ILHIGUN1i5 <br />GPWP PLUMBING <br />BnSErnENi MECHANICAI. <br />❑ YES ❑ NO <br />HEIGHT LIMi7qTiON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUIL�ING SUPCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />� <br />� <br />� <br />