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QPPLICATION FOR CONSTRUCTION PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PR�lT <br />BUILDING DEPARTMENT �— <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />OWNER MAILAOOBE55 <br />';,�, /�; Ho.,� i���z SF tve <br />T T � MNL ADORESS <br />��or{ . 7 nJ <br />ARCHITEC qDESIGNER IAAILRJDFESS <br />,GENERAL CONiRACTOR MAIL �DORE55 <br />��ipncf ��Pcrlricnl //3a�c /+-1u.lk;�t <br />ME ANICALCONTRACTOq MAILAODRE55 <br />PLUMBINGCONTflACTOR MAILAODflE55 <br />CONTRACT PRICE OF WURK <br />✓ /6 oa, �^' <br />DESCRIBE WORK A�D SOUARE FOOTAGE INVOLVED <br />�� O� Lva�� S�nn�' X �� <br />„ _ � ... _,. ,� . <br />PROPOSE� USE OF BUILOING <br />Sn v� <br />LEGAL CESCRIPTION OF PROPEflTY (SHOWN BELOW <br />LOT 6LOCN OF <br />PARCELTAXI.D.NUMBER <br />CONSTRUCTIONLOPNLENDER.ADL .ESS.TELEPHONE <br />PLUMBING <br />0. TYPE OF FIXTUHE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREV <br />ROOF DRAINS I <br />SINK ISERVIC AR, <br />HEATING SYSTEM: ❑ GAS ❑ <br />C] BUILDING <br />COPIES) <br />� <br />Ll <br />ZIP <br />❑ <br />L ❑ PLUMBING <br />PHONE <br />3.�.r — /s <br />PHONE <br />PNONE <br />PNONE STATE LICENSE p <br />� 31-1--0 T'^^p�`cc A o•�3 <br />,�c._ nnr <br />I PHON STAT rLICENSE M <br />NO. <br />STATE LICENSE a <br />a3s' -2��- <br />s6s- - 7 �s <br />IWI BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />A CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />VISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />OT. 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 />PERFORb1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOFS LAW 18.27 RCW AND 296.200 WAC. <br />/ <br />oFiE% <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />� A/C—A/HNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />i UNIT HEATERS—B.T.U. M <br />� <br />' CLOTHES DRYERS <br />' VENTILATION FAN <br />� qANGEHOOD <br />; WATER HEATER <br />� WOODST <br />; METAL FI CE ( D BURNING) <br />� FIREP E I RT <br />! HEAT PU , <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FR09TSETBACN REARSETBACK <br />USEZONE — LOTAREA <br />��K <br />TYPEOFCONSi. NO.OFSTORIES <br />51.'EOFBLOG. FIRESPRRJHL[RSREO'D <br />OCCUPANCY LOAO FIRE ALAPM flE0'D <br />REASON <br />CLANS APPROVED BV <br />UATE <br />SIDE SE78ACN <br />❑ YES ❑ No BUIL�ING <br />OCCUCAO[Y t10 9fp.vEIL�NGULi15 <br />eAouv PLUMBING <br />BnSEM11ENT MECHANICAL <br />❑ YES ❑ NO <br />MEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />T.".� ���� IS 3105 TOTAL <br />FEE <br />SU8 TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FEE <br />i <br />I <br />� <br />