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APP�ICATIC _J FOR CONSTRUC7 JN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC 0 <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION CI COMBINATION i_1 BUILDING fJ MECHANICAL ❑ PLUMBING :� SIGN <br />OWNER �U l.rP�F`A�J,L �� �I��C/7 /--,�'L�Y ��VF11 /fZ(�[ PHON�� /_IS�I <br />f 1�1j u <br />TENAN�D��V` ��ILAD�q$ �ia.��/��w� /_�. �e� 98208 PHON339'�57� <br />2 cv <br />ARCHITELTORDESIGNER MAILADDPE55 CITi ZIP PHONE <br />GENERALCONTR9C�TOR MAILADDRESS CITY ZIP PHONE STATELICENSER <br />j.�2fty /�� IN�• P.� BoX 5269 GYNNwoor7 G!A •98oy� 77�•p835 ReRR N�oB3�S _ <br />CHANICALCONTRACTOR MAILAUDflE55 CIN ZIP PMONE STATELICENSE/ <br />PLUMBINGCONTRACTOFi MAILADDRESS CITV ZIP PHONE STATELICENSEk <br />CLA55 OF WORK <br />�NEW L 1 ADDITION C] ALTERATION IJ REPAIR I. I DEMOLITION f l WOODSTOVFJFRPL INSERT I�.I BUILDING RELOCATION <br />��O¢�� � CONTACTPERSONANDPHONENO. { <br />CONTRACTPPICEOFWORN I�N M C�rrRv� ������rS _ <br />DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED /.� _ _ <br />PHOPOSEDUSE <br />LEGAL <br />LOT <br />OF PROPEHT' (SHOWN BE101 <br />BLOCK OF <br />ADDRESS <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEN' <br />ROOF DRAINS—RAIM1 <br />SINK (SERVICE—BAF <br />OR ITEM <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOURCOPIES) 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 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 />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 W�TH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />USEZONE LOTAREA <br />C�� <br />rvocnvrnurc ennWABLE 7YPEOFCONST.ACTUAL <br />BLDG. NO.OFSTOPIES <br />NCVLOAD FIRESPflNNLERSREO'U <br />B� PLANSAPPROVE�BV <br />�/�/� � <br />SIDE <br />MECHANICAL <br />FEE NO. 7YPE OF EOUIPMENT <br />� A/C—AIHNDLG UNITS—H.P. <br />; � FORCED AIR SYSTEMS—B.T.U. M <br />, UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� HANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />IECK N BER <br />3 �''�� <br />VACANT SITE 1'C W <br />BUILOING <br />acuveecr xo.ovow[wxeuxrts <br />exoua � PLUMBING <br />BASEMEN7 MEC4ANICAI <br />HEIGHiLIMITATION ADDITIONALPLANCHECK <br />cPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 rorn� <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAI.FEE $ ' <br />RECEIP NO. <br />i7 � �oos� <br />VALUATION FEE <br />"'� i �. <br />� <br />i <br />i <br />i <br />�2Z <br />i <br />i <br />�D <br />� <br />i <br />� <br />'nS �/l '� % 2 <br />