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APPLICATIQ^! FOR GONSTRUCT�'1N PERMIIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ _ � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ D�MOLITION i i COMBINATION CI BUILDING I l MECHANICAL SCI PLUSNBING ❑ SIGN <br />pOWNER IdAIL ��DRESS GI7Y ZIP PHONE <br />U�� � nn1A \A��(-L� s�oa �Tl� ��IP vJ2�' �JPkPaT��n q11)�' �14a'(�353$ <br />TENANT M IL 4D���E55 CITV ZIP � PHONE <br />FRCHITECTORDESIGNER MAIL�D�RESS GTY ZIP PHONE <br />GENERAL CONiRACiOH � M�L ADDRESS' ' �I � � pTV ZIP � `I ?H ��� �7 STATE LICENSE+1 <br />�n � <br />Iv�CJY V�) vv �� <br />MECHANICRLCONTRACTOR MAILADDRE55 CITY ZIP PHONE STATEUCENSEn <br />PLUMBINGCONTflACTOR MAILAD�RESS CITV ZIP PHONE STATELICENSEb <br />CONTRACT PRICE OF WORN <br />DfSCRIBE WORK AN� SOUAf <br />INVOLVED <br />1N�, C <br />�� <br />PROPOSED 11SE OF BUILUING I <br />LEGAL UESCRIPTION OF PROPEPTV �SHOWN BELO'N OR ATTACH TV✓O COPIES� <br />LOT BLOCH OF <br />PARCELTA%I.D.NUM9ER <br />CONSTRUCTIONLOANIENDER,ADDRE55.TELEPHONE NUMBER <br />PLUMBING <br />0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) _ <br />SHOWER <br />KITCHEN SINK 8 DISP <br />- DISHWASHEfi <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOU(vTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.) , <br />SUB TOTAL S <br />PERMIT S <br />TOTAI FEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN PEAR SETOACH <br />CSEZONE LOTAREA <br />TYPEOFLONSi NO.OFSTORIES <br />SIZEOFBLDG. FIRESPRINKLERSREQ'D <br />OCCUPANCY LOAD FIRE AIARM flEOD <br />IN7AKEBY PLANSAPPROVEDBY <br />DATE <br />FEE <br />0 <br />� <br />I� <br />0 <br />CONTACT PERSOY AND PMONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANO KNOW THE SAME TO BE TRUE AND GORRECT. ALL <br />PROVISIONS OF !.AWS AN� ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL aE �OMPLETED 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 �T}15 PROPE Y TO PERFORM THE WORK FOR WHICH <br />APPLI ATION�IS MAD AND I COMPLY WITH THE STATE <br />CONT ACTORS�.AW 182 CW AND 296.200 N/AC. , <br />N0. TYPE• OF EQUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MFTO.L FIREPLACE (WOOD BUR <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />PLANCHECNNUMBEF <br />vnCaNi siiE FEES <br />❑ YES ❑ NU BUILDING <br />acwzm:r r;oo�onaucsuwrs <br />cnoua PLUMBING <br />BASEIdENT MECHANICAL <br />❑ YES ❑ NO — <br />HEIGHTLIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCA! SALES <br />TAX CODE IS 3105 rorn� <br />� <br />SUB TOTAL $ ; <br />PERMIT 5 � <br />TOTAL FEE 5 ' <br />FEE RECEIPTNO. <br />VALUATION FEE <br />—� <br />i <br />i <br />i <br />i <br />�p <br />X <br />� <br />� <br />