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�. :,- _ <br />APPLICATION FOR CONS": RUCTION P�RMIT <br />TO BE COM:�'STED IN BLACK INK—PLEASE PRINT "` ����v�rr <br />BUILDING DEPART ENT HEATING SYSTEM: f] GAS f� ELECTRIC U <br />L5DEMOLIT ON Cl C�IN TION �� ❑�ILDINU 3/ /1=1� C��ANICAL zn/ C P UMBI G3/��IGN <br />OWNER M�I�AO�qESS CITV ZIP PHONE Q6"'_��'� <br />.'Lv-:�i. �..i.�._..., __ .�_ . ._ . . . _ . ( <br />iEN�HT <br />M�IL AOORE55 <br />ORDESIGNEfl MAILADDRESS <br />cin <br />ZIP PIION[6 <br />PHONE <br />0 <br />GENEf1�LCONTflqCiOR MAILADDRE55 �ITY IIP PHONE SfATELICENSE■ <br />MECII/.NICALCONiRACTOF lANLFD�RE55 CIiY ZIP PlIONE STATELILENSE��f79/N/G066qP <br />l�J�,.. . . . _ _' <br />GOIRR4CT PqICE OF WORK <br />�� <br />UESCRIDE WOAK AND SOUAqE F� <br />�G✓_ �!�/L(' G�/T <br />�( / d G'oPi9✓-3�d <br />PROPOSED USE OF OUILOING <br />/i�! <br />LEG�L �ESCRIPiION Of PROPER <br />LOT BLOCN — <br />PARLELTpXI.D.NU�dOER <br />�Sc%� 7 dCJi G <br />GONSiRUCTION LOAN LENDEP. A[ <br />lC1/�i� if'/>i�9�1/`T <br />PROJECT ADDRESS <br />790�� <br />PLUMBING <br />��� 00 <br />ib.� <br />INVOLVED <br />TYPE OF FIXTURE <br />WATER CLOSET ITOILETI <br />LAVATORY (�YASH BAf <br />SHOWER <br />KITCHEN SINK t DISP <br />DISIiWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRIMKING <br />BACKFLOW <br />ROOF DRAI <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK � REANSETBACK <br />� <br />USE20NE LOTAREA <br />c-� <br />71PEOFLOIISI. NO.OFSTORIE: <br />SIZE OF BLOG. <br />OCCUPPNCYLOAD <br />fiEASON <br />INT�NE �V <br />OF <br />PERMIT $ <br />TOTAL FEE $ <br />FIRE SPRINNlERS REO'D <br />FIRE ALARIA <br />A., <br />- S.4S <br />♦ <br />cvA• <br />FEE <br />VAC�NT SIiE <br />❑ YES ❑ NO <br />OCCOCINCY 11001N4'[IUiIGUN115 <br />GNWP <br />O�SEMENT <br />❑ YES ❑ NO <br />CiTY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />Z�P P��ONE STATE IICENSE a <br />CONi�Cf PERSON AND <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 />WORK WILL BE COMPLETED WITH WHE'fHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCci THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUI.ATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STAT[ <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />�..ri <br />s �etunE �E <br />LIIT OU5�11[55 LICENSE NO. <br />NO. TYPE OF EOUIPMENT <br />NC—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 />VENTILATION FAN <br />RANGEI100D <br />WATER HEATER <br />METAL FIREPLACE <br />HEAT PUMP <br />EXHAUSTFAN <br />PLAN CHECK NUMtlER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCH�RGE <br />PUBLIC WORKS <br />TOTAL <br />SUBTOTAL $ � <br />PEflMIT $ ; <br />TOTAL FEE 3 � <br />FEE ^� � /; <br />U `'/ <br />�J <br />b <br />