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APPLICATIC� FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />u s ri+� <br />HEATING SYSTEM• ❑ GAS ELECTRIC � <br />BUILDING DEPARTMENT ' - � � � t' � <br />259-8810 <br />i i DEM�LITION COMBINATION BUILDING MECHANICAL �UMBING I� SIGN <br />ONTlE MAIL A�ORESS �ITY ZIP PMONE <br />L�`—�au�/-,✓,K �ca,Q1�1 I- 6�/•to /f�s�lA•�l F1. Eww1f 9�0� Z-S'Z3 y <br />TEN�NT MMIADDRE55 � � CITY 21P PHONE <br />M�auc�,K Cps...1, zzij Fa..�a/ F_ �yr�-(i S,�zo � ��a - 6� 4 b <br />ARCHITECTO ESIGNER pILADDRE55 CITY 21P pHONE <br />__ S'v/ F <br />��.�e�n�cun�nnc�un Mnanooeess arv <br />S-. (� <br />MEGMRNICALCONiR�CTOq MRiLpDDRESS GTY <br />PLUMBINGCONTRAGTOR MAILA�URE55 OTY <br />.S�/F <br />CLASSOFWOflK - - <br />�. NEW ADDITION � ALTERATION REPAIR DEMOLITION .. WOODSTOVE/FRPL INSERT '. '� BUILDING RELOCATION <br />j GONTACT PERSON AND PHONE NO / n <br />/ � �.r, � LF LIS�I�/�l. � ) �'7�� <br />CONTR�CT PNICE OF WORK l�S�P� �%�- I� �J � � L✓� R I� <br />DESCRIBE W/ORK AND SOl1ARE FOOTqGE INVOWED � � /� <br />fi[1tI i�RNNA�I, Y6LN q� NnC�GIVS' �lc�'f /SuI'� ' %�S�.Y�_ <br />ZIP <br />nr <br />PMONE STATE LICENSE I <br />PMGNE STATE LICENSE t <br />PHONE STATELICENSC� <br />PROPOSEDUSEOFBUROMG / <br />LEGAL DESCRIPTION OF PROPERTY �SHOWN 6ELOW OR ATTALM FOUP <br />�o*�_ e�aK %$�GCJ �ijV, <br />vnaecr nnoRess <br />�ZI\ <br />LAVATORY�WAS <br />SHOWER <br />KITCHEN SINK 8 <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS--RAIN <br />SINK (SERVICE—BAR <br />SUB <br />FOR OFFICE USE ONLY: <br />FRONTSETBACH REAqSETBACK <br />O� Zo' <br />USE Z LOT AREA <br />�� <br />iVFEOFG RS.ALLOWABLE i'!PEO CONS7.AC1Ul <br />_� 'I� <br />SREOFBLDG. NO.OFSTORIES <br />2�7 a Ann.� �% <br />FIRE SPPNKLERS PEO'D <br />N� <br />REASON FOR SPRINNlEFS <br />INTAN[ BY <br />FEE <br />T <br />� �_ <br />i HEREBY CERTIFY THAT I HAVE READ AND ExAMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 L'�AC. <br />x.���� ''� �° 1�'��s'l'�' S'-a��'Z <br />SiG �IUFE D�tF <br />NO. � TYPE OF E�UIPMENT I FEE <br />lVG—NHNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATER�B.T.U. M <br />CLOTHES DRYERS <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERi <br />HEAT PUMP <br />GAS PIPING <br />5 � � � TOTAL FE <br />� <br />' ///. i3 . <br />SIDE SETBALK PLRN CHECN��/{�MBEF � FEE <br />, B I7 D I�� G� <br />VFCANT SITE FEES VALUATII <br />� BUILOING 17�'00 pi.a.✓ <br />aCueAHCv Nooiw:FLLixcuNrts <br />�'" ° � 1 PLUMBING _ <br />OaSEUErvT MECHANICAL <br />D <br />HEIGHTUMITr1T10N ADDITIONALPLANCHECK <br />�SPFINKLER <br />S7ATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX CODE IS 3105 �TAL <br />$ <br />$ <br />J <br />� <br />