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APPLICATIC�I FOR CONSTRUCT'�lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />H <br />BUILDING DEPARTMENT EATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259•8810 <br />C:! DEMOLITION f i COMBINATION !?'BUILDING ' 1 MECHANICAL L! PLUMBING ❑ SIGN <br />'Oe�WNEP IdqIL��OPESS'/q / <br />J � �. / ! �GI �i�/l� G7d'U /y � PHON[ <br />._....._ . �'��9�u���.�w.�t+ Z-���� 3�3-9z�y <br />MAIL <br />nRCHITECTORDESIGNER MML4DDPciS <br />�'�h.�.� <br />GITY 2iP PNONE <br />C11Y ZIP PHONE <br />. _ ....._._.. ......_..______ �ii� c�� nNn[ STAIEL�GENSEp <br />Gw N-�� <br />MECHANICALCONTRACTOR M/dLADORESS CITY ZIP PHONE STATELICENSE• <br />PWIdBING <br />MAIL ADOFESS <br />CRY ZIP <br />CONiRqCTPRICEOFWO� �� ` � <br />v <br />�ESCRIBE WONK AND SOUAFE FOOTAGE INVOLVED <br />{>t�fy�c IJtcF� �� (�.-ini' �� FFa�s�C� <br />�i'�{ `b 2-S�o�Y DEcic <br />PROPOSEO USE OF BUILDING <br />LEG4LOESCR�PTIONOFPROPERN�SHOWNBELOWO iTACHTWOCOPIES) <br />' ��V <br />�o; �— e�«N 7 5 oF l fi <br />/��4 � � � r-W`t 7�i <br />PARCELTA%I.D.NUMBEP <br />CONSiflUCT:ON LOAN LENDER. ADOflESS, TELEPHONE NUMBER <br />l J I=ie/.wVc � �LY �-e 1� <br />FU(TURE OR ITEM <br />SHOWER <br />KITCHEN SINK & DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />SUBTOTAL <br />F'ERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSET�ACN <br />USEZONE �pT�REA <br />7YFEOiCONSi NO.OFSiOFIES <br />'�` <br />52E OF OLDG FIRE SPRINKlEFS REO'� <br />E�� s-tG � <br />OCCIIPANCYLOFD FIREAIARh1RE0'� <br />FEASON <br />BY PLANSAPPROVEUOV <br />JW <br />DATE . � Ii � ! <br />CONTACT PFRSON AN� PHONE NO. <br />�Gx /y ���us h�i., <br />STATE LICENSE e <br />Z3 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 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 CG:?PLETED 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 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 18.27 RCW AND 296.200 WAC. <br />������ : <br />Si ruae oar[ <br />FEE N0. TYPE OF EOUIPMEN' <br />� fV�A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILArION FAN <br />RANGEHOOD <br />' WATER HEATER <br />WOODSTOVE <br />; METAL FIREPLACE (WOOD BUF <br />; FIREPLACE INSERT <br />� HEAT PUMP <br />' GAS PIPING <br />�— EXHAUST FAN <br />PLANCNECN <br />VACANT SITE FEES <br />�; VES ❑ NO BUILDING <br />octuv,wcr uaorownurvcurvits <br />,aou3PLUAIBING <br />BASEIAENT MECHANICAL <br />r�ves � No <br />MEIGHTLIMITATION ADDIiIONHLPLANCHECK <br />OTHER <br />STATE BUILDING SURCHAFiGE <br />CITY OF EVERETT PUBLIC WOFKS <br />LOCALSALES <br />T,4X CODE IS 3105 TOTAL <br />FEE <br />FEE I RECEIPT AO. <br />