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APPLICATIO^. FOR CONSTRUCTI JN PERMIT � <br />TO BE COMPLETED IN BLACK IIdK—�PLEASE PRINT <br />EUILDING DEPARTMENT HEATING SYSTEM: IJ GAS ❑ ELECTRIC U <br />259-8610 <br />IXXDEMOLITION i I COMBINATION I 1 BUILDING I I MECHANICAL I l PLUMBING i I SIGN <br />OWNER IAAILp00RE55 CIiY ZIP PHOHE <br />R.R.C.R. Associal•es, 1429 Broadwav. Everett Wa. 258-1414 <br />IEN�NL IAAILAOORE55 QTV 21P PHONE <br />Vacant <br />�RC111TECTORDESIGNER M�ILpDDRE55 CIiV ZIP ���ONE <br />GB�ER�LCOHIRACTOP MRILADDRE55 GiY ZIP�VO—JJO-7J/�/�NE SiAIELICENSE� <br />Welch Enterprises Inc. P. 0. Box 366 115 Lind Street, Mt. Vernon, Tda. 98273 1092 <br />MECIIANICRLGONTqACTOR MAILAODRESS CITV ZIP PHONE STATELICENSE� <br />MAIL �UDRE55 <br />CONTqqCi PRICE OF WORN <br />DESCRIBE WO�H AND SOUARE f001�GE INVOLVED <br />CITY ZIP PHONE StRiELICENSE� <br />the Everett Fire Denartment and then debris <br />rnoroseo use oF eunowc <br />LEGAL DESCiiIPtION OF PROPER7Y ISNOWN BELOW OR ATTACN TWO COPIES) <br />lOi BLOCK OF <br />Beg NE Cor NF.'�, NEi,:, I�Id'Z, Th W 94.71 I�t to <br />Sely Sdy St. Rd ro. 1, Th Swly alg s S y <br />t.. mvn r,rr. (Sac. 17_ 'hun 29. R 5) <br />Fl�RCELT�XID.NUMBER <br />1%29�5-2-�i <br />� <br />TELEPNONE NUMBER <br />fADDRESS <br />N. Rroadway, Units 7& A, Everett, Ida <br />IBINO <br />TYPE OF FIXTURE OR ITEM FEE <br />WATER <br />SHOWER <br />KITCHEN SINK 8 <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNiAIN <br />FI.00i1 DRAIN <br />BACKFLOW PREVENTERS <br />POOF DRAINS—RAINLEAC <br />FOR OFFICE USE ONLY: <br />FRONTSE7BRCN RE4RSETBACK <br />IYCE Of COH57 <br />S12E OF BLDG. <br />OCLUPANCVL <br />PF.�SON <br />INiGNE BV <br />SUB TOTAL <br />NO OFSTONIES <br />FIRE SPIiINNLERS REO9 <br />FlRE ALARM REOD <br />PLANS APPROVED BY <br />D�iF <br />$ <br />SIDE SETO�CK <br />AND PHONE NO, <br />Steffen <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7VPE OF <br />WORK WILL BE COMf'LETED WITH WHETHER SPECIFIED fIEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PAESUME TO GIVE <br />AUTHORITY TO VIOLATE OP CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING C�NSTRUCTION OR THE <br />PERFORA4ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH <br />APPLICATION IS MADE AND I COMPLY WITH THE S1ATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x ��^ry�'�� /�jy�yY" <br />S�GNn1UnE <br />LI1Y qU51HCSF IICCNSL NO _ <br />TYPE OF E�UIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />HOOD <br />WOOD STOVE <br />METAL FIREPIACE � <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />TOTAL <br />$ <br />$ <br />� I FEE I RECEIPTNO. <br />7 !� <br />❑ YES ❑ NO BUILDING ' <br />otcur�r�cr rro aowtu�xuM�s ' <br />GP01v PLUMBING � <br />i <br />BASEMENI MECHANICAL i <br />❑ YES Cl NO ' <br />HEIGNT uMITAiroH A�DITIONAL PLAN CHECK � <br />i <br />OTHEA __; <br />i <br />STATE BUILDING SURCHARGE � <br />i <br />CITY OF EVERETT Nuouc woaKs � <br />LOCAL SALES � <br />TAX COUE IS 3105 TOTAL � <br />