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APPLICATIQ�' FOR CONSTRUCT"'1N PERMIT � <br />TO BE COMPLETED !N BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYS7EM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION Ci COMBINATION y'� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OKTJER � MAILADDRE55 CI7Y ZIP PMONE <br />9RVr/� ;�'1,�� 5ue �,�old 9�� ,B,rcc�rrl� Ei)�.� a�'a�� asa-7y73 <br />TENANT MAILAUDRESS LITY ZIP PMONE <br />SQ�I Y � , <br />APCHRECTORD[SIGNER MAILA��RE55 CITY ZIP FHONii <br />GENER`AL CONTRRCTOR MFIL AODRE55 pTV ZIP PHONE 'pTE LICENSE t <br />PLUMBINGGONTRACTOR MAIL�DDRE55 <br />WOiiK <br />3� <br />cm <br />PRO�P ^SEDUS✓EOFBUI�OING <br />C � GI� <br />LEGAL UESCRIPTIDN OF PROPENTY ISHOR'N �ELOW OR ATTACH TWO COPIES� <br />LOT BLOCH OF <br />PAPCELTA%ID.NOMBER <br />s93a �a� vo� �oo� <br />CONSTRUCTiONLOANLENDER.RDDRESS.TELEPHONENUMOER <br />.._"_' �.__' ' <br />� / � J`j!'O!! , <br />PLU6IBING <br />N0. TVPE OF FI%TURE OR ITEM <br />WATER CLOSET ITOILETI <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—RAINLEADE <br />SINK (SERVICE—�AR, ETC.) <br />FEE <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />fRONi SETBACK / REAR S�LK/ <br />` �, <br />OSEZONE LOTAIiEA <br />-2 <br />TVPE Oi CONSi. NOAF STORIES <br />� <br />SIZE OF BIDG. FIRE SPRINKLERS RE00 <br />PEFSON <br />ov a�nNsn;Pqoveoov <br />�J p <br />DATE "j Ii �G� <br />SI�E <br />ur rnUnt :•ATELICENSEa <br />21P PHONE STATELICENSE� <br />i HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GDVEFNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF �FECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES IJOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THL PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB.27 RCW AND 29620U WAC. <br />MECHANICAL <br />N0. TVPE OF <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEAS <br />VENTILATION FAN <br />RANGEHOOD <br />METAL FIREPLA _ � <br />FIREPLACEINSERI' <br />HEATPUMP <br />GAS PIPING <br />❑ YES ❑ NO pUILDING <br />IX[OiA4LY HO O�GNfLliN6114i15 - <br />-eouv pLUMBING <br />M'� � <br />BeSEMENT MECHANICAL <br />i7 YES �..:, NO - <br />NE�GHturniinioN ADDITIONALPLANCHECK <br />Z� � OTHER <br />STATE BUILDING SURCHARCE <br />CITY OF EVERETT ru�uc woaKs <br />LOCALSALES <br />TAX COOE IS 3105 rorn� <br />M <br />FEE ' I RECEIPTNO. <br />.3S / �7 <br />