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APP�.ICATIQ ; FOR CONSTRUCT'"1N PE��n681'TG <br />TO BE COMPLETEU IN BLACK IN;(—PLEASE PRINT F���s�, <br />HEATING SYSTEM� ❑ GAS ❑ ELECTRIC ❑ <br />BUILDiNG DEPARTMENT � <br />259-8810 <br />❑ DEMOLITION y COMBINATION ❑ BUILDING i� MECHANICAL ❑ PLUMBING U SIGN <br />OWNER �_ MAILAODRESS CITV _ 21P PHONE <br />MAIL <br />AR,^,HITECiORDE5ICNER !/.AILA��RE55 <br />CITY � ZIP PHONE <br />CITV 7.IP 7NONE <br />GENERAICONiRACTOR MAILAD�RE55 CIN 21P �HONE STATE�ICENSE� <br />( J1��,�a w� ( ��-Szc Z.� l i� i.a 5�� L���,� �2 ! 50�1 ti�-�s�� wa �r� ��' 0�,3 R�O <br />MECHhNICALC0IJTRACTOR MFILADUfiE55 CI7Y ZIP PHONE a'Ai[LICENSEa <br />PLl1M�INGCONTFiACTOR MNLADORE55 <br />CONTRACTPR EOFWORK <br />�%Soc� <br />�ESCRIBE WORK AN� SOUARE FOOTAGE INVOLVED <br />Tf..,..�� {'.i.rr�:_. 1�R(�O - <br />PROPOSED USE OF BUILDING ' � ' ` <br />�in1l �n14`� <br />IEGAI OESCPIPTION OF PROPERTV �SHOWN BELOW OR ATTACH TWO CG°IES) <br />LOT 6LOCK OF — <br />PAFCELTAXI.D.NUMBEfl <br />GONSTRUCTIONIOANLENDER.ADDRESS,TEIEPHONENUMBER <br />PLUMBING " <br />O. TYPE OF FIXTURE Ofl ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />LAUNDRV TRA`/ <br />CLOTHES WFSHER <br />URINAL <br />DRINKING FOU� �TAIN <br />FLOOR DRAIN <br />BACKFLOW PRE'JENTERS <br />ROn� DRAINS�-RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE 5 <br />FGR OFFICE USE ONLY: <br />FRONTSETOACH REARSETBACK <br />USE ZONE <br />iYPEOfL�T _ <br />N <br />$/II�`F.,�OF B�LDG.� ( <br />IW C/�'�'I�.0 <br />OCCl1PAI ICV LOAD <br />G Ati <br />FEASON <br />IHTAKE BY <br />N0. OF SiOPIES <br />FIRE SPR^IIJdLERS flEU'D <br />/ L� <br />FIRE �LA'RItd REO'0 <br />NV <br />PLANS <br />DATE <br />SETBACK <br />qTY ZIP <br />CONTACT PERSON AN� PHONE NO. <br />PHONE <br />x <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 ANO ORDINANCES GOVERNING THIS TYr'E OF <br />WORK WILL BE COMPLETED WITH WFIETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TJ GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF /�NY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTICN OH ThE <br />PERFORMAhlCE OF CONSTRUCTION. THAT I AM AUTHORIZ�D BY THE <br />OWNEii OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br />APPLICATION IS tv1ADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1027 ACW 4ND 296.200 WAC. <br />/l� �.� 2��1�. _Q/��- <br />,,,n ne onte <br />CiLY OUSINE55 LL:ENS[ NO <br />FEE NO. TYFE OF EOUIPMENT <br />i AI�A�HNDLG UNITS—H.P. <br />; FOFCED AIR SYSTEMS—B.T.U. M E.A. <br />� �NIT HEATERS—B.T.U. M <br />—�— -- <br />� CLOTHES DRYERS <br />' VENTILRTION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOGSTOVE <br />� METAL FIqEPLACE (WOOD BURNING) <br />; FIREPLACE INSE'nT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUST FAN <br />T— <br />' SUB TOTAL 5 <br />PERMIT S <br />� TOTAL FEE S <br />���IR� I FEE .�'. � ^ � RECE�DU /�" <br />/( U � <br />VACANT SITE FEES <br />❑ YES I.I NO BUILDING <br />OCCII�ANLY p00�0'NFll�tfll\JS <br />°"°' � PLUMBING <br />� <br />�nSE1dENT MECHANICAL <br />�l YES k" NO <br />MEIGHTLRdITAT10N ADOITIONAL PL1N CHECK <br />OTHER <br />STATE Bl11LDING SURCIiAAGE <br />f,ITY OF EVERETT PUBLIC WOPKS <br />LOCAL SALES <br />TAX COOE IS 3195 TOTAL <br />T <br />�/� ��;71 <br />