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APPLICATIC�1 FOR CQN�TRUCT'1N PERMIT �� <br />TO BE COMPLETED IN BLACK INK—PL�ASE PRINT <br />BUILUING DEPARTMENT <br />259-8810 <br />I DEMOLITION <br />HEATING SYSTEM: 'J GAS J ELECTRIC J_ <br />COM6INATION BUILDING <br />�` MECHANICAL PLUMBING <br />SIGN <br />�f�IVI L � lrt'xN(� <br />PWfE��NGCO'ITRACTOR IAAILADOFE55�) /� CITY ZIP PMONE — ST�TEIICENSEs <br />/(r <br />CONTPnGT—��dKri <br />C S1=- <br />DESC�IPF 1VORK PND SCJAFE FOOT�GE INVOLVE� <br />���� �'KC: S�� <br />PROPOSEO <br />LEGAL �ESCRI'TION OF Pf JPEFTY ISHOWN 8[LOW OR PTTACH TWO COPIES� <br />LOT — BLOCK O <br />�.�-, � !1 �rr�-, � rs�— <br />PARCEL TAX 10. NU1.19EP <br />CONSTRUCTION LOAN LENOEH. <br />TYPE OF <br />CLOSET <br />{S. TELEPHONE Nl. <br />C/V �' / /� <br />URE OR ITEM <br />LAVATORY�WASH BA: <br />Sr;OWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />C�OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />flOOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR. ETC <br />SUB TOTAL 5 <br />PEP.MIT 5 <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FPOM1TSETEACN REARSETBACN <br />JSE ZONE <br />ivPE OP CONSt. <br />SRE OF 3LDG. <br />FEASON <br />AREA <br />FIf1E "PINNLERS REO'D <br />LOAD � FI9E ALAflhI REO D <br />iNTf.h[BY PLnNS\�P�,P^ROVEDBY <br />onrEJ�'11��I /jj <br />CONTACT <br />I HEHEBY CERTIFY THAT I HAVE READ AND EXAMI�ED THIS <br />APPLI(;ATION AND KNOW THE SAM.E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIIJG THIS TYPE OF <br />WORK NIILL BE COMPLETEU WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOL.4TE OR CANCEL THE PRO�ISIGNS OF A�V <br />t�THER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOfiS LHW 1B 7 CW AND 29B 200 WAC. <br />�.. � l��N l�� <br />FEE NO. TYPF OF EOUIPh1ENT <br />/llC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />VENTILA7IGN FAN <br />RANGEHOUD <br />� WATEF HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BI iRNMG) <br />FIREPLACE INSERT <br />� HEAT PUMP <br />FAN <br />SIDESETBACK PLANCNELKNl1MBEP FEE <br />�� �/�� <br />va� nNT Si7E FEES <br />�] YES . '� NO BUILDING <br />occuo.�;cr .ro ar mvEuinc uv�.�s - <br />�now PLUId81NG <br />BASEMENT MECHANiCAL <br />YES NO <br />HEIGHT uMiTATION ADDITIONAL PLAN CHECK <br />_ OTHER � „�.�,��i• J_ <br />STATE BUILDI SURCHARGE <br />CITY OF EVERETT aueuc woares <br />LOCAL SALES <br />TAX CO�E IS 3105 T�TAL <br />SUBTOTAL $ <br />PERMIT S <br />TOTALFEE S <br />i <br />