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A,PPLICQ'�14 _� FOR CONSTRUCT _ �N PERIVIIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �'��� <br />BUILDING DEPARTMENT �~"'�''' �x�iCM: � uA5 V ELECTRIC ❑ I <br />259-8810 <br />I i DEMOLITION � COMBINATION BUILDING i I MECHANICAL XPLUMBING SIGN <br />UWNER IAAILA�ORESS CIN 2IP PHONE <br />Sessows �ai�oit �13��- Rl�`�✓t S� Lvrt `/�`�'��g g34-ad45 <br />TENANT MAILADDRE55 CITY 21P PMONE <br />ARCHITECTORDESIGNIiR MAILAUORE55 CITY ZIP PNONE <br />GENEHAL CONTRACT .fl MqIL ADORESS <br />IA�IL AODRESS <br />'ysu�He f1w�6,wt.o IR31S SR � <br />SSOFWORN a <br />NEW � 1 ADDITION i i ALTERATION <br />CONTRACT <br />DESCRIBE' <br />LOT <br />PflOJCCT <br />: AND SOUARE FOOTAGE INVOLVED <br />„ {��u..bi r <br />OF BUILDING y�-� <br />ah. s�4u� <br />'I NOFPROPERTV�SHOWN�ELOK <br />_ OLOCK _ OF <br />PLUMBING " <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY �WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHEfl <br />LAUNDRYTqAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADER� <br />FOR OFFICE USE ONLY: <br />FRONTSETOACK REFRSET <br />USEZONE LOTAREA <br />TYPE OF CONTS, ALlOWAOLE <br />SREOFBLOG. <br />OCCUPANCVLOAD <br />REASONFORSPflINKLEPS <br />INTAKE �Y <br />CITV Z�p <br />�J"� `'78: <br />CITY ZIP <br />CITY Z�p <br />PHONE STATE �ICENSE a <br />10 Y69t PuGST'blr <br />PHOtlE SIATELICENSEa <br />PHONE STATE LICENS[ M <br />�� � REPAIR i'� DEMOLITION '��. ' WOODSTOVE/FRPL INSERT .�. BUILDING RELOCATION <br />ICONTACT PERSON ANO PNONE h0. <br />•+no Q-OL`JS or �<�e ���n7 y3S SS.SS <br />�uee� �ior�, <br />i HEREaY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BF TRUE ANU CORRECT. ALL <br />dTTALHFOURCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING TiiIS �fYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFiM1T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF qNV <br />OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� BY THE <br />OWNER O� THIS PROPERTY TO PERfORM THE WORK FOR INHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAbV 18.27 RCW AND 296.200 WAC. <br />��G� ��I�y <br />SiGNFI HE pAtE %— <br />SUB TOTAL 5 <br />P[RMIT $ <br />TOTAL FEE 5 <br />1YP: OF LOIISi. ACNAL <br />NO. OF STORIES <br />FIFE SPPNKLERS <br />PLANS APPpOVED BY <br />SIDE SET6ACK <br />VACANT SITE <br />FEE NO. TYPE OF EQUIPMENT FEE <br />A/C—A/HNDLG UNITS�—H.P. ', <br />; FORCED AIR SYS I EMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M ; <br />' CLOTHES DRYERS � <br />' \�ENTIlATION FAN � <br />� RANGEHOOD , <br />; / 1NATER HEATER <br />' <br />WOOD STOVE ' <br />' METAL FIREPLACE 8 CHIMNEY � i <br />� FIREPLACE INSERT � <br />� HEAT PUMP , <br />� GAS PIPING � <br />� <br />� EXHAUST FAN . <br />PLANCHECKNUMBER I FEE <br />BUIIDING <br />O[GOPA1•CY h0 OfCNFIIPiGUHiiS <br />�poOP � pLUMBING <br />BASEIAENi MECHANICAL <br />HEiGNTLI67I7AnON ADDI(IONALPLANCHECK <br />SPRINKLER <br />STATF BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WOfiKS <br />LOCP.L SALES <br />TAX COOE IS 3105 TOTAL <br />SUB TOTAL S � <br />PERMIT $ ; <br />TOTAL FEE S � <br />N0. <br />a <br />� <br />fl <br />