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APPLICATI( .i FCn CON -STRICT 3N PERMIT !- <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT c' <br />HEATING SYSTEM: U GAS J ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810MECHANICAL (1 PLUMBING I"1 SIGN <br />❑ DEMOLITION `-I C1LlOMBINATI/ON�L ty�,,'I 1 BUILDING 1 11l' ZIP 1I—D y/ }1 �I 1PHOONEE� J\ G 1 <br />OWNER MAIL 1� V�ADDRESS <br />cue vi 1'ITL . NLfI W\/ c Vl.�l 1 , W I � <br />PHONE t f <br />MEl..HANICALCONTRACTOR MAILACDRESS <br />o�Yn,Prc n+£cN a1718 661bA <br />_ ...._...........on�,rn: �— !.bllL ADDRESS <br />CONTRACT PRICE OF WORK <br />i . S00 <br />CITY <br />sn:.-le�o7 lH.w,�l/a <br />IESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />Add_ <br />N y>OY� ILL f.1w) Al rill: <br />S10 vse ex I' AC spadd NZW— i <br />PROPOSED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXI.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />OF <br />{INK & DISP <br />1ER <br />TRAY <br />SINK <br />SUBTOTAL $ <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR' <br />USEZONE ILOT AI <br />TYPE OPCONST. I NO.O <br />SLOG. FIRE SPRINKLER <br />NCV LOAD FIRE ALARM REC <br />I <br />BY PLANSAPP0% <br />DATE <br />l <br />ZIP <br />.706 <br />ZIP <br />NTACT PERSON AND PHONE NO <br />LICENSE t <br />E <br />LICENSE t <br />LIC <br />crsv£LDSR• <br />(Sw.�2o Ewa I ti+strl <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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />GRANTINGNOT. THE APERMIT DOES NOT PRESUME TO I <br />VE <br />AUTHORITY To VIOLATE CANCEL THE PROVISIONS OF ANY <br />LOCALOTHER STATE OR <br />PERFORMANCE OFCONSTRUCTION. TH THATAUTHORIZEDCONSTRUCTIONAM 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 16.27 RC'N AND 296.200 WAC. <br />1165, �tm <br />+—� BATE <br />i5SNCENSE NO <br />NICAL FEE <br />TYPE OF EQUIPMENT <br />O—NLG UNITS—H.P. <br />RSYAIE' <br />INITHEATERS—B.T.U. M ' <br />)LOTHES DRYERS <br />IENTILATION FAN <br />iANGE HOOD <br />NATER HEATER <br />NO STOVE <br />METAL FIREPLACE tVVUUU BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />PLAN <br />JACANT SITE <br />❑ YES ❑ NO <br />BUILDING <br />MI.a MLIVIGUNIIS <br />PLUMBING <br />MECHANICAL <br />S ❑ NO <br />!8MA.SEMENT <br />ADDITIONAL PLAN CHECKMITATION <br />OTHER <br />--� <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SALES <br />TAV rnnP IS 91n5 <br />TOTAL <br />FEE <br />