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APPLICATIC 1 FOR CONSTRUCT��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: �GAS � ELECTRIC J <br />259-8810 <br />i: � DEMOUTION i_: COMBINATION f i BUILDING i MECHANICAL PLUMBING i 1 SIGN <br />��'ER MAILAUDRE55 �ITV ZIP PHONE <br />.7"osc,o.,� ilx�.�r,� �7 z Cc� �- El� � z� � � s9� y?�'�i <br />TENANT MAILADDRESS CITY ZIP PHONE <br />APCHITECTORDESIGNER M�ILADDRESS dTV ZIP PHOI�E <br />GENERALCONTFnCTOR IAAILADDRESS CITY ZIP PMONE SiATELICENSE• <br />IdECNANICAICONTRRCTOR t!InILADDRESS ,P�� B✓1� rS�'(J� r�S� . Z�p pa�� PMONE STqTELICENSE� <br />L.V�-- O <br />E�Q}� 5` s/ff�T.+ �xL /6//F �i�/.'/�'c Gd�i rF' cv. �jjzr� Z>-�- /Y E7'ifX' s5�t/.E-7 <br />PWMBMGCONTNACTOR IAAILADDRE55 qTY ZIP PHONE STATELICENSEe <br />T PPICE OF WORK <br />av � <br />WORK FND $OUARE FOO7AGE INVOLVED <br />PROPOS[D USE OF BUILDING <br />LEGAL JESCRIPTION OF PROPEBTV �SHOWN BELOW OR ATTACH TWO COPIES� <br />LOT BLOCN OF <br />PAACELTA%ID.NUMBER <br />CONSTRUCTIONLUANLENDEF,AD�RESS.TEIEPHC <br />PROJECT ADDRESS <br />S1 L COL/y ,41t, <br />PLUM8ING <br />N0. TYPE OF FIXTURE OR I <br />WATER CLOSET�TOILET) <br />E3l�THTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS-RAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK RERR: <br />iYPE Of CONSi. <br />S2E OF BIDG. <br />occuraNcv�oao <br />REASON <br />INTAKE OY <br />SUBTOTAI <br />PERMIT <br />TOTAL FEE <br />LOT AREA <br />NO. OF STORIES <br />FIFE SPRINNLERS FEO'D <br />FIRE AL�RM RW'0 <br />PL�NSFPPROVEDBV <br />DATE <br />SI�E SETBACK <br />CONTFCT PERSON AND PHONE NO. <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO CIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PPOPEATY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />Xs'Ga.-�P"/—l'� /O-/3- `�c/ <br />$�GNRil1AL OA1[ <br />cirr nusn[ss � iarvsc r�� - � <br />FEE N0. TYPE OF EQUIPMENT <br />A/C-A'HNDLG UNITS-H.P. <br />; FORCED AIR SYSTEMS-B.T.U. <br />UNIT HEATERS-B.T.U. M <br />. CLOTHES DRYERS <br />VAGANT SITE <br />i= YES ❑ NO <br />OCCpCRN.Y I N� W pNTLLMGUNi15 <br />4BOOF <br />BASEMENT <br />f ,' YES I.:! NO <br />NEIGHT LI!d1TqT10N <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />VENTILATION FAN <br />AANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />META� FIREPLACE <br />FIFEPLACE INSERI <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECN <br />OTIIER <br />SiATE BUILDING SURCHARGE <br />PUDLIC WOfiKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />fEE � RECEIPTNO. <br />