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APPLICATIO. . FOR CONSTRUCTI W PERMIT � <br />TO BE COMPLETED IN BLACK INY.—PLEASE PRINT �T <br />HEATING SYSTEM: J GAS J ELECTRIC J_ __—� <br />BUILDING DEPARTMENT r — <br />2b9-8810 C <br />� DEMOLITION � ��✓CO <br />BUILDING MECHANICAL PLUMBING SIGN <br />OWNER ' I(,�` MMl �DDRE55 Crtv ZiP vr urv[ <br />In%ICt�$tJ2oM J � � � Qc`RrSn.ae j)�z_ _ '�rn��_l.,1f� • $?o; 353-oyP�/ _ <br />LEN�Ni MAIL�DDRE55 CIiV ZiV Pi�ONE <br />pnCNitEGTOFDESIGNER M�II�DDRE55 G�iv 2�P PMONE <br />SN�q.�,� C'o,vsr. i 1 zz 5 �� I1R. s� ��e�r /,�g. qs�zos 5�,o��rosi � r <br />GENERRI CONiR�CTG9 M�II ADOf11[55 CiTV ZiP PHONE SiAiE UCENSE � <br />MECH�NICAL CONTH�LTOR M�IL �UDRE55 CITY ZIP PHONE ST�TE IICLNSE • <br />CONTRACTOR M�IL�DDRE55 <br />PqILE OF WORI( <br />SOUAPE fOOUGE <br />PNOPOSEOUSEO�BWIDMGc.I' <br />T�1f6 � <br />� LEMI DE1S'CRIPTION F PROPENTY �SNOWN BELOI <br />LOT�LA-- BLOCN —� OF <br />P�RCELTA%Ip NUMBER <br />� <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV�WASN BASIN) <br />SHOWER _ <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORY T�iAV <br />CLOTNES W!•SHER <br />URINAL <br />�RINKING FOUNTAIN <br />FLOOR ORA�N <br />BACKFLOW PAEVENTERS <br />AOOF DRAINS--RAINLEADERS <br />SINK (SERVICE—BAR. ETC.) <br />FOR OFFICE U�E ONLY: <br />FNONiSETB�CN -�.RE�R GEtBACN <br />USEZONt <br />TYP[ Of CONSi <br />512E OF BLDG <br />OCCIIPANCYLO�D <br />HE�SON <br />INT�NE BY <br />SUB TO <br />PERMIT <br />TOTALF <br />LOT �RE� <br />NO Of S10{iIES <br />FlRE SPRINI(LEPS REO'� <br />flRE ALARM REO D <br />PUNS APPROVFO BV <br />DAiE <br />LITv <br />�.. <br />TWO COPIES� <br />� <br />PHONE ST�TE UGENSE � <br />PERSON AND PMONE NO <br />i HEREBV C[RTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />WORK WILL 9E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCtION OR THE <br />PERFORMANCE OF CONSTRUCTION. TY,A� I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PEfiFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1027 RCW ANU 296200 WAC. <br />N0. <br />NC— AMNDLG UNI75- <br />FORCED AIR SYSTEM'. <br />UNIT HEATERS—B.T.U. <br />CLOTIIES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACEIWI <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />SIDE SETB�CN � PUN CHECn NUMBER <br />VACANT SITE YttS <br />� �� YES � � NO BUIIDING <br />aav.r. xoaoxiu�wcw��is — -- <br />rwauv p�UMBING <br />BASEMENT MECNANICAL <br />"�� YES � � NO <br />NEIGMTI�MITATION A[1DITIONALPLANCHECK <br />OTHER <br />S7ATE BUILDI4G SURCHRRGE <br />CITY OF EVERETT aueuc woahs <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />U. M E.A. <br />SUB TUTAL <br />PERMIT <br />�EF � REGEIPTNO <br />N <br />d <br />T <br />� ;�U <br />