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APPLICATIQ`' FOR CONSTRUCTI�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ` GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION i=I COMBINATION ❑ BUILDING �MECHANICAL � PLUMBING Cl SIGN <br />OWNER <br />I. <br />IdA1L AUDRESS <br />�.Qq�f noo-ulao0 �0.. <br />MA L AD�RE55 <br />CITY ZIP <br />= vf.rt�ror 9�: <br />an zir <br />ARCHITECTORDESIGNER MAILADDPE55 CITV 21P PHONE <br />GENERALCONTflACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEII <br />�e�+rlv.u:A{� nca�b �-es�R.NIl� ���.N•��c E�a�- 9��3 :c��7-�i/� .I1f���lFi�(e(t0.11tA <br />MECHANICALCONTRACTOR MAILADDRESS CIiY 21P PMONE STATEIICENSE� <br />PLUMBINGCONTHACTOR MAILADDRE55 CITY ZIP PHONE STATELICENSEM <br />CONTRACT PRICE OF WORK �� �I 2{� <br />rnunt <br />oc <br />0 <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPER7Y �SHOWN BELOW OR ATTACH TWO COPIES� <br />LOT BLOCK OF <br />PARCELTA%I.D.NUMBER <br />CONSTRUCTION LOAN LEI <br />CLOSET <br />KITCHEN SINK 8 DI: <br />DISHWASHER <br />LAUNDFVTRAY <br />CLOTHES WASHER <br />URINAL <br />BACICFLOW <br />ROOF DRAI <br />SINK (SERV <br />OR ITEM <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN REAR SETBACK <br />USE20NE LOTAREA <br />ttPEOFCONST. NO.OFSTORIES <br />512E OF BLOG. FIRE SPRINNLEFS FEO'D <br />OCCUPANCY LOAD FIRE ALARM REO'D <br />REASON <br />INTAKEBY PLANSAPPROVEDBV <br />OATE <br />SIDE SETBACK <br />CONTACT PERSON AND PHONE NO. <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 UF <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 1 AM AUTHORIZED BY 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 296.200 WAC. <br />NO. <br />OF <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />FANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (W000 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />❑ YES ❑ NO gUILDING <br />occuo�xcr xoorow[wxcuxus <br />"AWP PLUMBING <br />BnSEMENT MECHANICAL <br />❑ ves ❑ No <br />NEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 rora� <br />FEE <br />SUB <br />E� <br />0 <br />� <br />