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AP�L1��1TI��W Fr3� CONS�'EiUC"!''''O�1 PERI�IT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT t <br />Hf_ATING SYSTEM: �SI,GAS ❑ ELECTRIC U <br />BUILDING DEPARTIv1ENT <br />259-8810 <br />❑ DEMOLITION I I COMBIP�.4TION Il BUILGING �MECHANICAL ❑ PLUMBING CI SIGN <br />OWNER M�Ii�Of�RE55 CITY � \ 2�'_ ' ��r PHO^^—I '_^ "_ . <br />PN011E <br />ARCHITECTOROESIGNffl MAILA�ORESS �SITY � ZIP / PbONt <br />GENE(I�L CONTR�CTOR MAIL ADDRESS CITV ZIP PIIONE STATE LICENSE I <br />�¢cunumni I:oNTRACTOR MALL'A��RE55 _, ITY ZIP PH�NE STATELICENSER _ � <br />LEG�L <br />LOT <br />!'ROJECT <br />CONiflACTOFl <br />WOfiK <br />f7 ADUITION I�I ALTERATION <br />-----...__.. �K77R�' <br />O° PflOPERTY �SHOWN BELOW ON ATTACH <br />BLOCH OF <br />N0. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />OR ITEM <br />KITCHE� SINK 8 DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PREVEN' <br />I,OOF ORAINS—fiAl� <br />SINK (SERVICE—BAF <br />SUB <br />FOR OFFICE USE O^ILY: <br />TYPE Of GOIIIS. PLLuv <br />SIZE OF OLDG. <br />OCCUPANCYLOA� <br />pEA50N FOfi SPRII <br />INTAKE BV <br />AREA <br />NO. OF STORIES <br />FIFE SPRNKLERS REO'D <br />CITV <br />STATE LICENSE 1 <br />I 1 RcPP.IP. I I DEMOLITION I I WOODSTOVE/FRPL INSERT 17 BUILDING RELOCATION <br />-- � r.aNrncr rensoN n�+o rrior+e r+o. <br />SIDE SETBACN <br />6�70-1968 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND Y,NOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TNE 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY INITH THE STATE <br />CONTRACT RS LAW 18.27 CW AND 296.200 WAC. <br />SG��nfUFE � E �� <br />FEE NO. TYPE OF E�UIPMENT <br />� .NC—NHNDLG UNITS—H.P. <br />� � FORCED AIR SYSTEMS—B.T.U. M E.A. <br />�—I—I I INI7 HFAT[FS—B.T.U. M <br />RAt:GE HOOD <br />W.1TER HEATER <br />WJOD STOVE <br />METAL FIRcPLACE C CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP 3=fOIJ <br />GAS PIPING <br />SUB TOTAL <br />S <br />p�ANCHECKNIlA10EF I FEF. I f1ECEIPTNO. <br />VACANT SITE r«.� <br />BUILDING <br />OCCUVR�KY NOp:Y[IOMGUNi15 <br />�AWP FLUMBING <br />DASEIAENT MECHANICAL <br />IIEIGHTLIMITATION AD�ITIONALPIANCHECK <br />SPRINKLER <br />STATE UUIL�INC SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />0 <br />O <br />� <br />