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N3`i ll <br />APPLICATIC 1 FOR CONSTRUCT" 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: �I G4S U ELECTRIC J =__� <br />BUILDING DEPARTMENT <br />259-8810 <br />� DEMOLITION ! I COMBINATION BUILDING }(MECHANICAL PLUMBINa i SIGN <br />IOWNER MAILpDORESS � LITY 2iP FHONt <br />�RRn/K T�E' u � s /L �/ ��ve�� y �Cic ✓v ��,- 98203 35.7 s �. %S -- <br />TENANi <br />MAILpDDRE55 LITY Z�P PN�'° <br />�RCNIiELTORDESIGNER MAILR�DRESS <br />CITV ZIP PHONE <br />GENERALGONTR�f,TOR MAIIADDNE55 <br />GTY ZIP PMONE SiAiELIGENSE� <br />IAEGNANICRLCONTPACTUR MAILADUNESS CITY ZIP PNONE SiATEL'CENSE� � <br />�p,?�'ifT£C�.af S£o✓�c£ 2328/1>.�l�[L S: {v: SG'zo/ Z598/87 �ais.,.aGSo3oGJ <br />vniunmof.oNiP4LTOR MAILRDDNESS <br />GTV ZIP PNONE STRiELIGENSE� <br />CONTRAGi PRICE OF WORN <br />2000 �O <br />DESCfiIBE WORK AND SOUpRE FOOTAGE INVOlO�D <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTV �SNOW N BELOVI OR ATTACN TV.'O COPIES� <br />LOT BLOCN Of <br />PARCELT4%ID ��UMBEF <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TFiAY <br />CLOTHES WASHER <br />URINAL <br />DRINNING FOUNTAIN <br />FLOOR DFAIN <br />BACHFLOW PREVEN7 <br />ROOF DRAINS—RAIN� <br />SINK 1SERVICE—BAR <br />FOR OFFICE USE ODILY: <br />FPONTSETBACK FEARSET <br />USE 20NE ���T �REA <br />1�?E Oi COVSI NC UF Si <br />SIIF. OF BLDG <br />OCLUPANCYI <br />Rli0.K[ BY <br />FIPE SPRINHLERS REOD <br />�IRE ALARM RE00 <br />DAiE <br />FEE <br />$ <br />$ <br />PERSON AN� 1'110NE <br />£ X � ✓.�1/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TVPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 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 />PERFORAIANCE OF CON�TFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORIA TVIE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1027 RCW ANO 296200 WAC. <br />� l2EX �y.�.✓ �-.7/-5'i� _ <br />swrv�iunc o [ <br />PIAN <br />OF EOUIPMENT � FEE <br />FORCED AIR SYSTEMS—B.T.Uj�M E.A. <br />WATER <br />WOOD <br />PUMP <br />'IPING <br />UST FAN <br />�: VES �� N� BUILDING <br />aa�vnic xnaowu���.<,v��is <br />cao��o pLUMBING <br />BASEMENT MECHANICPL <br />-� YES :—� NO <br />MEIGHTLIMRATION AODITIONALPLANC�iFJK <br />OTHLR <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COGEIS 3105 rorn� <br />SUB <br />FEE <br />FEE fiECEIPTNO <br />M <br />�X <br />no <br />XM <br />e <br />i <br />� <br />