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c <br />APPLICATIOO FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑__ _.- <br />259.8810 // <br />❑ DEMOLITION ❑ COMBINATION FAUILDING 6 MECHANICAL ✓PLUMBING LJ SIGN <br />n .F. wa.fDdiE55 CITY PP PHONE 2C•%Z�. <br />IL ri cfx�M el� gn�'�'dk0.MNl3J YoS f / syl FF TT i(MV1.0k CA. 90 ca l <br />PO• dog. 73397 <br />MMBNGCCNTRACIOR `MAIL <br />' <br />ZIP <br />31B <br />PI NE <br />wa <br />EULELCFNSE/ <br />9fs373 <br />;HENE <br />STATE LICENSE <br />L/G <br />C���y <br />3y �1� B. <br />^TA^^TTT <br />C— TRACT PNICE OF WOi1R <br />0 3 <br />PE RI DE WORN ANDSWARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PII'J1@ NO. <br />Y <br />ek — 310- 32�-a3ou <br />1/�C111.✓iA.�j� <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 />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 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 LqW ,1X8 227 RCW AND /29966.200 WAC. <br />N �I•AV`lVAV7''( `W <br />,1 AL <br />PROPosco usE OF BmL01 D r <br />e,A Q/ 1 <br />LEGAL DESCflIPTKk10F PROPERTY IS, EELOWOR ATTACH TWOCWIESI <br />LOT—BLOLP. OF <br />PARCEL TAX 10 NUMBER <br />CONSTRIICTIN LOAN TENDER. ADDRESS. TELEPN011E NUMBER <br />PROJECTADDRESS II —(QZ 4 C2 iYR <br />Wu <br />s.cnnuNf o.rz <br />G.+BYSW.S9LKfMf p <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A'HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS —BTU. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />ROWER <br />THIES DRYERS <br />HEN SINK B DIED <br />VEN TION FAN <br />CIS ASHER <br />RANGE 0 <br />LAUND TRAY <br />WATER HEATE <br />CLOTHES SHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE IW BURNING) <br />DRINKING FOUNT <br />�— <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADER% <br />EXHAUST FAN <br />SINK (SERVICE —BAR, <br />SUB TOTAL S <br />SUB TOTAL $ <br />" <br />PERMIT $ <br />PERMIT $ <br />TOTALFEE $ <br />TOTAL FEE $ <br />;_ <br />cne ncnnc ITec nul v. <br />FRONTSETSACK <br />REAR SETBACK <br />SIDE SEIOACN <br />PIAN C=ECY NUMBER <br />CJj 5 <br />FEE <br />/7'— <br />RECEIPT NO. <br />USEZOIIE <br />LOTAREA <br />VACANT SITE <br />Ll YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />p- <br />!00 <br />TYKDF=T'' 11 <br />—)V <br />NO. OF STORIES <br />I <br />amlrn[r KPumuFDUPn <br />cRaP <br />SITE OFBLBt <br />3 EIS <br />FIKSPRNKLERS REDD <br />P�Yb_pn YP9 <br />SASEMEW <br />❑ YES 0 NO <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />OCCUPANCY LOAD <br />OI <br />FIRE "AM RED <br />ho <br />NEIDNT LPARABDN <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />NTAKE BY <br />NANSAPPflpVEOBY <br />TL <br />WTES—r -�Fj <br />CITY OF EVERETT <br />LocaLsnLEs <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />