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APPLICATIO' ' FOR CONS7RUCTf�N PERMIT ~��� <br />7'O BE COMPLETED IN BLACK INK—pLEASE PRINT � <br />BUILDING DEPARTMENT I_ <br />259-8810 <br />DEMOLITION i i COMBINATION <br />o�vraca r.im�aoor,E;s <br />%u�rE �/c�2�' /oh FcRu,�'n <br />7[NANi MAILAppR[SS <br />HEATWG SYSTEM: �'GAS `] ELECTRIC 'J <br />� ' BUILDING k <br />cirv zii <br />Eve�'e-r"r `IS <br />CIiY �p <br />MECHANICAL �PLUMBING f 1 SIGN <br />PNON[ <br />;�C� ; 353-3335" <br />PIIONE <br />r1RCHIiECTOR�ESIGt�ER MnILADORE55 CIiV <br />Z�P PHONE <br />GIfNERr1LCONTRpCTOR IAAILApOFESS Cli <br />Z�P PHONE STFTE LICENSE � <br />NEc,HANIC4lCONiF�GiDR MMLADDRE55 CITY <br />Z�P PHONE 5T4TE LICENSE • <br />PWM�INGCONTRACTOR MAIL�DDR[SS ��ry - <br />PNONf. � <br />��p�.f� ����� �/ � STATELICENSEr L�- <br />e .� 3/ �G ��c--���7r /ti%�// �C�.t�/ �i�CT/ �6�.10,� �S -�C31 i�F <br />CONiRACT PNICE 0F W0 K ! - j ES/32ti1 7 <br />�00' �u.%�� �10.ive �M�\� � I E�-�--3�-�� <br />�ESfRIBE WqRK FN� SOUABE FOOTAGE �NVOLVF� <br />T.dS�Ot �� /D ri ) � ��� <br />_ C1n_:f< <:7S ".�''—; <br />c�ef �"a 9a� C/' a.�i/ <br />PROPG�ED USE Of BWLDIN <br />/(E6iden.'cE <br />IEGAL OESCRIPTION OF PROPERTY �SIIOWN BELOW pR ATTACH T WO COPIES� <br />Ln( OLOCK OF <br />P/RGELiAxt.D.NUMBER <br />'Y777-no0 -G/�o -�ooj— <br />CONSTRUCTiONLOAN�ENDER.A'd�RE55_Te�.eaHnuv <br />Nn� ?VPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />Y,ITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBFCK qppq; <br />uSEZONE <br />7YP'.OFCONSi. <br />SRE OF O�OG. <br />OCCUPANCYLOFD <br />RenSON <br />iNrnKe ev <br />LOTAqEA <br />NO. OF SiORiES <br />FIAE SPRINKLERS flE0'D <br />=1qE ALARM REO'0 <br />PLANSAPPROVEDBY <br />onre <br />FEE <br />CONTAC i PEfl50N qND PMON[ NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICAI ION AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE 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 LAN/ REGULATING CONSTRUCTION OR THE <br />PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWh�ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAI'ION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 HCW AND 296.200 WAC. <br />TVPE OF E�UIPMENT <br />NC�G UNIiS—H.P. <br />.41R SYSTEMS—B.T.U. M <br />�TERS--9.T.U. M <br />CLOTHES DRl'ERS <br />VEtJTILATION FAN <br />RAIJGE HOOD <br />WAfER HEATER <br />WC�D ;TOVE <br />METALFIREPLACEi <br />FIREPLAC�� INSERT <br />HEAT 1'i:rdP <br />GAS PIPIWG L <br />EXHAU:�T FAN <br />$ <br />S <br />SIDESETBACN I PLAN <br />VACANT SITE FEES <br />-1 YES .-�� NO 9UILDMG <br />���>���Y N� �10'MIIiM1GUM1liS <br />G�CJv <br />PLUMBING <br />BqSE61ENT MECHANICAL <br />i YES NO <br />r+eict+r uMrtnnoH 40DITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TO7AL <br />� <br />SUBTOTAL $ �_�[Z <br />PERMIT $ <br />TOTALFEE $ <br />PEE RECEIPTNO. <br />VALUATION FEE <br />i <br />� <br />i <br />i <br />i <br />r <br />� <br />� <br />� <br />