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APPLICATIC-1 FOR CONSTRUCT �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br />HEATING SYSTEM: _I GAS ❑ ELECTRIC No� —� <br />BUILDING DEPARTMENT <br />259-8810 <br />---------_'--- . . _...._..... : �ucnu.u�n.� - ��o111u01ur � 1 RI(:N <br />MAIL A�ORE55 <br />�� <br />M L ADDFE55 <br />LITV <br />CIiY <br />� <br />qRCHfTECTORDESIGNER IAAILADDRESS CRV ZiP <br />GEf�PR CONTRACiOR MAIL AODRE55 CRV ZIP PHOHE STATE LICENSE � <br />�%�u`r�.2�' <br />MECHANIG4L CONTRACTOH 1ARIL �DDRE55 CITY ZIP PMONE STRTE LICENSE t <br />PLUMBING CONTRACTOR MAIL A��RESS GITV ZIP P1qNE STPTE LICENSE � <br />GONTFRGTFNiC WORK %% � <br />�1I5� J <br />�CSCRIB[ WORN �ND SOUAP[ FOOTAGE INVOIVED CONTAGT PERSON ANO PHONE NO. <br />rA1 � <br />r^ '�.. �r"� i— ti,� Ti' S4. T. /`1 <i-J V—p _ <br />C� <br />LEGAL DESCRIPi1pN OF PROPENiV <br />LOi� BtOCH — <br />PPBCEL1AM10 NUMBEP <br />3 �G_3 - (:DU - G! <br />CONSTAUCTICN LOAtI LENDER. AD�RESS <br />NO. TYPE OF FlXTURE <br />WATER CLOSET �TOILET) <br />BATHT�9 <br />LAVATO(iV (WASH BASIN) <br />SHOWEf; <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDFVTRAY <br />CLO7HES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE—BAR, E <br />OF <br />i HEREOY CEfiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROViS10NS OF LASNS AND ORDINANG�S GOVERNING THIS TVPE OF <br />TwoCOviesi WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br />NOT. THE GRANIING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE P70VISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PFRFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WIiICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COWTFACTORS LAW 78.27 RCW AND 296.200 WAC. <br />NUMB[R <br />TOTAL $ <br />�AIT $ <br />�L FEE $ <br />]fli <br />TYPE OF EOUIPMEN" <br />A/C—A'HNDLG UNI'S—�H.P <br />FORCED NRSVSTEMS—B?.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VEN7ILATION FAN <br />RANGEHOOD <br />WATER HEATEti <br />WOODSTOVE <br />METAL FlREPLACE (WOOD BUI <br />FIREPLACE INSERT <br />GAS PIPI� <br />EXHAUST <br />SUB TO <br />PERMIT <br />TOTALF <br />FOR OFFICE USE ONLY: <br />FHpNT SETORCK FEAR SETB4CH � $�DE SET04CN ' PLAN CH - K N�MB[R / FEE <br />Z6 • �• � O�.Lcs %�'..�L� <br />use y�ye � �oT naen vncnNi si*E ,� FEES VALUATI <br />C� i VES I-1 NO pUILDING �yy <br />TMEOiLON'ai. NOOFSTORiES at[Uvr�u[r NOarnttuiN4uwr5 <br />c4ouo / pLUMBING <br />512EOFBlDG FIqESPPINKLERSR[O'D B/SEMENT � � MECNANICAL <br />52 �0 I ! YES f�!NO <br />AODITIONAL PIAN CHECK <br />OCCUPANCYLORD iIREALANMREO'D HEIGHiLIlAIT�TION <br />J OTH[R <br />FEASON <br />STA7E BUILDING SURCHARGE <br />INTAKE BY PlANS RP!'A� BY CITY OF EVERETT PU9LIG WOPKS <br />J LOCRL SALES <br />DATE C � 9f' <br />TAX CODE IS 3105 rotn� <br />V <br />� <br />� <br />$ � <br />$ <br />aECEI�NO �� <br />(1' � <br />F-- EE � <br />� ;_ <br />, <br />.�—i— <br />� <br />i <br />—�—�//i—hL/ <br />� <br />�_ � '� 'J`� <br />• � <br />