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APPLICATIC"� FOR CONSTRUCT"lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SY.iTEM: f] GAS ❑ ELECTRIC ��(/�j _� <br />259-8610 � <br />❑ DEMULITION ❑ COMBINATION '��SUILDING Li MECHANICAL ✓PLUMBING ❑ SIGN <br />OWNEP MFIL ADDRE55 CITY ZIP PHONE <br />GENERAL CONTRACTOR . 1•1FIL F�DPE55 CITV ZIP PHONE STATE LIGENSE a <br />IdECHANICALCONTRACiOF MAILADOFE55 CITY 2IP PHONE STATELICENSEk <br />PLUMBINGCONTRACTOR MAILAO�R[55 CIN ZIP PHONE STATELICENSEa <br />CONTRACT pPRICE OF WORK <br />_Ji' �nj% ' � <br />DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED <br />0 <br />PROPOSEDUSE <br />LEGAI DESCRIPTION OF PROPEFTV (SHOWN BELOW OR AiTrCH TWO COPIES� <br />LOT BIOGK — OF <br />�� �_— ��..�......, // <br />VARCELTAXI.D.NIIMBEH <br />/8'e2YdS- N <br />CONSTRUCTION LOAN LE1 <br />N0. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LALINDRY TRAV ,,a, <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF <br />SINK f <br />FOR OFFICE USE ONLY: <br />FRONiSETBACK FEARSETBACK <br />USEZONE <br />TVPE OF COI�ST <br />� <br />SIZE OF BLDG. <br />333 � . , <br />OCCIIPANCV IOAD <br />LOTAREA <br />� <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />SIOE <br />PIRE SPRINKLERS flE0'D <br />. G-0U�.p MALt. �vlu�liU� <br />INTnHE BY PLANS APPROVED BV <br />DATE <br />CONTFCT PEPSON AND PHONE <br />I HEREDY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />.^,PPLICATIO� AND KNUW 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 QR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORM17ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM 7HE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE £iTATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />��.���� /% � 0 7�30� Z . _ <br />S�GNniuRE � <br />LRY BIISINE55 tICENSE NO _ <br />FEE NO. TYPE OF E�UIPMEN7 ree <br />� A/C—A/HNDLG UNITS—H.P. � <br />� FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />� UNIT HEATERS-6.T.U. M � <br />� CLOTHES DRYERS ' <br />; VENTILATION FAN � <br />� RANGEHOOD ' <br />; WATER HEATER ,� <br />� WOOD STOVE . . . <br />FIREPLACE IN: <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />JACANT SITE ttt3 <br />� YES ❑ NO BUILDING <br />aavu:cr xa cvo�veiwmuurts <br />caouv �y pLUMBING <br />� .!/ <br />BnSEMEN7 MECH4NICAL <br />❑ YES 54' NO <br />HEIGHTLIlAITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY 9F EVERETT PUBLIC WOFiKS <br />LOCALSALES <br />TAX CODE IS 3105 rora� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />(/ I RECEIPTNO. <br />.zo 9�ti 7 <br />� 7 <br />N <br />