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APPLICATIC'1 FOR CONSTRUCT" �N PERMIT �� <br />TO BE COMPLETED IN BLACK INK—PIEASE PRINT �`T� <br />�. � <br />%l�elzl� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPHRTMENT <br />259-8810 <br />i_l DEMOUTION i i COMBINATION ! i BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />OWNER MAILADDRE55 LITY 21P PHONE <br />'��� �� � i I J <br />j%j � (:09 /�(len� �ar• J ;r .� . % �l F,J p ;_ 3 �'G 3✓rG <br />TENANT MAIL AODRE55 GITv 2lo PHONE <br />�/�-va�-I ' � _ __". <br />/- <br />FP.CHITECT Ofl OESIGNER MAIL ADDRE55 CITV ZIP PHONE <br />GENERRI CONTPACTOR MAIL RD6�iE55 CITY 21P PHONE STATE LIGENSE • <br />dL . T % J._. .,...- /r�._��.,.n� /.'..�nf'/ %B.i�'i u�>�3%//' !�,/.,d�(•ri/,+.i4 — <br />MAIL <br />PLUMBING CONTRACTOR <br />CONTRALT PRICE OF WORN <br />DESW 9E WORK AND SOl1ARE <br />�31' �(' a �, <br />�� '� �_ <br />AD�RE55 <br />�n •�� � "� <br />w ln / <br />LEGAL DESCFIPTIONOF PROPERTV ISHOWN BELOW OR ATTACH TWO LOPIES) <br />LOT BLOGN OF <br />ID.NUMBER <br />_ . —.� sn <br />TYPE OF FIKTURE OR Il <br />WATEP. CLOSET (TOILET) <br />BATHTUB <br />LAVAiORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAWLEADERS <br />SINK ISERVICE—BAR. ETC.) <br />�--- <br />FOR OFFIC� USE ONLY: <br />PRONTSETB4dK NEARSETBACK <br />USEZCNE LOTAREA <br />i�YEOfCONSi. NO.OFSiORIE! <br />TOTAL 5 <br />MIT $ <br />1L FEE $ <br />SIZE OF BLDG. FIRE SPPINKLERS REO'D <br />REASON <br />BY <br />FIRE �IARM RW u <br />PLANSAPPROVEDBY <br />onrE <br />CITY <br />21P <br />STATE LICENSE I <br />PHONE <br />NO. <br />>%'d /Gd i <br />k <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMIIJED THIS <br />APPLICATION AND KNOW THE SAME TO BE i RUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AtJY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORt.7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED OV TIi[ <br />OWNER OF THIS PROPEFTY TO PEFPORM THE WORK FOR WHIGH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COIJTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br />FEE N0. TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />� fORCLD AIR SYSTEMS—B.T.U. M <br />; UNIT NEATEHS— B T.U. M <br />CLOTHESDRVERS <br />; .NTILATION FAN <br />RANG[HOOD <br />WATEA HEATER <br />� WOOD STOVE <br />� <br />METAI FIREPLACE (WOOD BURNM( <br />; FIREPLACE INSERT <br />� HEATPUMP <br />; GAS PIPING <br />—� ExHAUSTFAN <br />SIDESETBAGK PLANCHECNNUMF3tN <br />VACANT SITE FEES <br />i_' YES ❑ NO BUn.DING <br />nccurexcv xoorwnmuauro�s — --- <br />cnoua PLUMBING <br />BnSEMEN7 MECHANICAL <br />❑ YES ��'—� NO <br />MEIGHTUMITATiON ADDITIONALPLANCHECK <br />OTHER <br />S7ATE BUILDING SURCHARGC- <br />CITY OF EVERETT Pueuc woaKs <br />LOCALSALES <br />TAX CODEIS 3105 iOTAL <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />O–ia— <br />0 <br />0 <br />N <br />