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APPi.ICATIC�1 FOR CONSTRUCT�)N PERMIT �� <br />TO EE COMPLETED IN BLACK INK—PLEASE PRINT <br />B�qLDING DEPAATMENT HEATING SYSTEM: ❑ GAS U ELECTRIC G_ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION f I BUILDING I l MECHANICAL CI PLUMBING ❑ SIGN <br />OWNER MFILAOORE55 CITV 21P PHONE <br />7 r�n�_/ /_I Il<�lr� �� ��o� y_ �cr't� S I L=UP.rc,{-� �IS�Q I �.`i �i- </S �l �SJ <br />TENFNT � � MAILA�DRESS CITY ZIP PHONE <br />GENEROLCONTF�CTOR <br />MECHANICALCONTRACiOF <br />PLUMBING CONTRFCTOR <br />CONTRACT PRICE OF WORK <br />WORK <br />PPOPOSED L�SE OF BUILDING <br />MAIL ADDRESS <br />MAIL ADDPESS <br />MAIL AUDRESS <br />LEGFL OESCP.IPTIQN OF PROPERTV �SHOWN BEIDW OR ATiFCM TWO COPIES� <br />LO' OLOCN OF <br />PARCELTA%IA.NUMBER <br />GONSTRUCTION LOFN LENOER, AODRESS. TELEPHONE NUMBER <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETI <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHF.S WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />SUB TGTAL S <br />PERMIT 5 <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBFCK REAflJETBACK <br />USEZONE <br />iYPE OF CONSi. <br />SRE OF BLOG. <br />��� <br />OCCUPANCVLOAD <br />�f—'— <br />REASON <br />INTAKE BY <br />LOT AREA <br />FIRE SPRINNLERS REO'0 <br />FIFiE ALAFM REO'D <br />PLANS APPROVED BY <br />J �d <br />onre l{-�2�i 3 <br />SI�E SET9ACK <br />CITV 21P PHONE <br />CITV IIP PNONE STATEUCENSEk <br />GTY ZIP PHONE STATEIICENSEp <br />QTV TIP PHONE STATE LICENSE q <br />CONTACT PERSON AND PHONE N0. <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 TY?E OF <br />WORK WILL 8E COMPLETED V/ITH WFfETHER SPECIfIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br />AU?IiORITY 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 PERFORM THE WORK FOR NIHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X �Qv�� �_ �i �cc.�.ca.l�. �!- z-q3 <br />siGNnrunE "/� o��E <br />Lilv fi05W F55 ULENSE NO <br />MECHANICAL <br />FEE NO. TVPE OF EOUIPMENT FEE <br />A/C—A/HNDLG UNITS--H.P. ; <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS-6.T.U. M ; <br />' CLOTHES DRYERS � <br />; VEhTILATION FAN ; <br />RANGEHOOD � <br />WATER HEATER � <br />�— WOOD STOVE <br />; METAL FIREPLACE (WOOD BURNING) � <br />� FIREPLACE INSERT ; <br />� HEAT PUMP � <br />i GAS PIPING ' <br />� EXHAUSTFAN <br />vncaNt Siie FEES <br />❑ YES ❑ NO BUILDING <br />OLWPANGY NOOipWfLLINGl111115 <br />cnouv PLUMBING <br />t7nSEMEnr MECHANICAL <br />❑ YES �.^! NO <br />HEIGHTLIIAITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDIN� SURCHARGt <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 70TAL <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE S <br />FEE I REGEIPTNO. <br />p0 <br />0 <br />�/ <br />