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� <br />APPLICATIO' � FOR CONSTRUCT! � N PE�iMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRiNT <br />'iu�g <br />� HEATING SYS7EM: xGAS J ELECTRIC J_— � <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLiTION COMBINATION <br />OWNER I.IAILADURESS <br />TENPNi lA�ILADDRE55 <br />S�/� <br />RRCHIIECTOFDESIGNER M�IL�DDfiE55 <br />/JONc" , <br />GENEFRICONiRACTOA MAIL�OORE55 <br />/�C/�iAJ,fs i�tr",f�iCt.P/ii, <br />t�ECNANiCAL CONTRRGiOR MAIL ADORE55 <br />S.9M�2 �98 C�ilP <br />niimniunctxJTRRC.TOR MRII�D�RE55 <br />LONTR�CT VRICE OF WORK � ^ ^ � � <br />V .� <br />BUILDING <br />CitY Ti° <br />�i2,� � � <br />CITV ZiP <br />CnY 2iP <br />��,� T�� <br />� /9<3 m� <br />Ciiv 2iP <br />CIiY 2iP <br />DESLNI WUnnnrvuo onnor ^� ^ � <br />— -"l%�� 1'M �in a (��L� <br />eNrMr�� ����t; T�2����; r�,J k�.� <br />_� A�i 1��,iti.1�l D�c.i l:F�i s <br />PPOPOSEDlISEOFBUIIDING �1��.`w`� ���( 1 � ^`� <br />� �K. rir/ <br />LEGAL DESCRIPiION OF PROPERiV jISHOWN DELOW OP A77�C 9 TWO CC�E51 <br />LOT��— BLOCN —L�— OF —i+='-=C���� <br />l, I' l� � 2- U U k-tMc, l0 U!= l�(lk <br />��/�.e `l� _ <br />PRPCELTA%10 NUMB[H <br />A��qESS.TELEPHONE NUMBEH <br />WATER <br />KI�CHEN SINK 8 DISP <br />FLOOR <br />�Q, L�S�ik_�, <br />ETC. <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FPONi5ETB4CR RE�R SELBACN <br />115E IONE lOT APE� <br />IVPE Of CON51 NO OF S70RIE5 <br />SIZE OF BLDfi FIRE SPRINKLERS RE00 <br />OCWP�NCYl0A0 FIREAIARMRE00 <br />RUSON <br />INT�MEBV PLANS�PPROVEDBV <br />D/.TE <br />MECHANICAL PLUMBING SIGN <br />PHONF <br />cJP�il �d-9 9�?n3 - 2nG,-.35if �.',i� <br />�„���E <br />PdONE <br />P„o�,Es.��.1F �1A1E LICENSE t " - <br />I!' .1i�1�19. /�Ci°r•'JR.S-/6S�(p.� <br />FHONE SUTE IICENSE � 3-� IS <br />PHONE STATE IICENSE • <br />I HEREBY CERTIFY THAT I I1AVE HEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT ALL <br />PROVISIONS OF LAWS AN� ORDINANCES GOVERNING tHIS TYPE OF <br />WORK WILL 9E COMPLETEU WITH WHETHER SPECIFIED HEREIN OR <br />NOi. THE GFANTING OF A P[RMiT D�1ES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOIATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFnRA1ANCE OF CONSTRUCTION. THAT I AM AUTHC?RIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFlK FOR WHICH <br />APPLICATION IS MADE AIJD 1 COMPLY WITH THE STATE <br />�ONTRACTORS LAW 18.2? RCW AND 296.200 WAC. <br />� o A <br />�J.�.,,�.0��4/�`° r-"/l�.<.l �/•7_,d`_�� <br />$IGN�1lIRF ���E <br />C11v puSMt SS l�:1 'S1 N!l �� <br />AIR S1'STFMS—B.T.U. <br />1TERS—G.T.U. M <br />iDRVERS <br />fION FAN <br />RANGEHOOD <br />� x WATER FiEATER <br />'— WOOD STOVE <br />METAL FIFEPLACE I <br />! FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />E%1'4UST FAN <br />0 <br />SIDESETBACN �^^�^��^^`^"""' —� <br />V�CRNT SIiE FEES _, _ <br />��� YES � - NO BUILDING <br />acw��vn noa�uw�uwr,w.�s <br />�°'�:" PLUMBIRG <br />pASEMENI MEChP.NICAI <br />... YES �. NO — — <br />NE�GMtLIMITATICN AD�ITIONALPLANCHECK _ <br />OTMER <br />STATE Bt11LD!NG SURCNA(iGE <br />�ITY OF EVEflETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COOEIS 3105 TOTRL <br />FEE <br />S <br />E <br />$ <br />