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APPLICAT6Q'`1 FOR �iI►I�1�4'F?«iCT'lI►1 <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />7 DEMOLITION ❑ COMBINATION <br />��'N�� MN�ADDRESS <br />�� ��l%�'s/%1 {i�//Y// L-sa^ �f/_ �.. , _ . <br />neHi irvc� �rs l EM: IJ GAS ❑ ELECTRIC ❑ <br />L I BUILDING_ fl M�CHANICAL ❑ PLUMBING , SIGN <br />CITV ZIf PMONE <br />......_.....,....,,, GTY " ZiP <br />PHONE <br />ARCNITECTOR�ESIGNEfI h1AILADDFESS �iTy Z�P <br />PHONE <br />GENERALCONTflACTOR AIAILADORESS �ii� Z�P <br />TiJr? �� . A/�L� aJ s� �_. i �/-+-. i i+ /) � _ PMONE STATE LICENSE I <br />MECHANICAL <br />AOURESS <br />CIN Z�p <br />'•"'••� alqltLlG[NS[P <br />PLUM�WGCONTRACTOR MAI.ADORESS CITv <br />Z�P PHONE STATE IICENSE a <br />CONTRACT P LE OP \VORN <br />-�' �q�t <br />PFOPOSE� USE OF BUIlOING <br />LEGAL DESCRIPTION OF PPOPERTY (SHOWN DEIOIYOq ATTpCH T1Y0 COPIESI <br />LOT BLOCN — OF <br />PARLELTA%�,D.NUAI'uER <br />CONSTRUCTION LOAN LENDER, <br />SHOWER <br />TELEPHONE <br />8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />FOR OFFICE USE ONLY: <br />FROt1T SETBACK Rcna e <br />USE ZQYE <br />C^� <br />NPc OF Co�1S� <br />SREOFBLOG. <br />OCCUGANCYL <br />REA£Ok <br />�NTAKE BY <br />J <br />FIFE SVRINKLEHS REOD <br />)TAl 5 <br />f S <br />FEE S <br />SIDE <br />� � YES NO <br />JCCJJAILY I.00fP1Fll1':illl:li$ <br />4xq�o <br />❑ YES ❑ NO <br />°IGMT LIl,llTAT10N <br />CITY OF EVERETT <br />�oca� sn�es <br />rax cooe is aios <br />CONTACT PEfi50N AND PHONE NO. <br />�� ' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVIS;ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK 4VILL BE COMPLETED WITH WHETHER SPECIFiED IiEREIN OR <br />NOT. THE GRANTING OF A pERMIT DOES NOT PRESUh1E TO GNE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TF,'E <br />PERFORMANCE OF CONSTqUCT10N. THAT I AM AUTHORIZED BY THc <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TIiE STATE <br />CO�RACTORS LAW 7 27 RCW AND 2g6200 WqC. <br />� ����--� -��- � 95� <br />`+�GIUiME ' <br />OAlE <br />FORCED AIR SYSTEMS—B.T.U. M E.A <br />UNITHEATERS—B.T.U. M <br />RANGE <br />STOVE <br />FIREPLACE W�� <br />HEAT PUh1P <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDING <br />PLUAIBWG <br />MECHANICAL <br />ADDITIONAL PLA�! CHECK <br />OTHER <br />STATE OUILDING SURCHARGE <br />PUOLIC WORKS <br />TOTAL <br />FEE <br />FEE �� <br />� 3 �f .!.__ <br />5 i — <br />S <br />a <br />