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APPLICATI�''"1 FOR CON'STRUCT'"1N PERMIT � <br />TO BE COMPLETED IN EtLAC.K, INK—PLEASE PRINT <br />BUILDING DEPARTMENT '— <br />259-8610 <br />f7 DEMOLITION ❑ COMBINATION <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />❑ BUILDING ❑ MECHANICAL Cl PLUMBING ❑ SIGN <br />lAAILADO ESS CItY ZIP Ynurvt �./ <br />OWNER R � �-� YvI Q I ( ��i ] <br />� RO�Iwc�Q� ("fOpet�le5 (cG7 5 'C ���vc _— <br />TENANT <br />IAqILADDRE55 CITY ZIP , PMONE <br />XR-ie�tawc%rs Ro>�.c�o�w � 607 S.i, C.iCYC�i' ��'/ad wA'i <br />ARCHITEGTOROESIGNER MAILAODRE55 <br />CITV ZIP PHONE <br />��n, Z�p PHONE STATEIICENSEa <br />GENERALGONTRACTOR MAILADDRE55 <br />MECMANICALCONTPAGTOR MAILADORESS <br />��TY Z�p PHONE STATELICENSEk <br />PLUMBINGCONiRACTOR MAILADDRESS CITV 21P PHONE STATELICENSE� <br />CONTRACT PRICE OF WORK <br />� FOOTAGE INVOLVED � L J <br />,� Gf�o�e %RG at�u � <br />(�tiae sa,.�.auN �+ <br />PROPOSED USE OF BIIILDING <br />LEGAL DESCFIPTION OF PflOPERTY �SHOWN BELOW OR ATTPCH TWO COPIES) <br />ioT e�aK oF <br />PARCELTAXI.D.Nl1MBER <br />CONSTRl1CTION LOAN <br />TYPE OF <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK & DISP <br />URINAL <br />DRAIN <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAF: <br />1SE ZONE <br />TVPE OF CONST. <br />SRE OF BLDG. <br />pGWPANCY L <br />REASON <br />INTAKE BV <br />TELEPHONE NUI <br />�� Me <br />RE OR ITEM <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />SI�E <br />LOT AREA <br />NO.OF STORIES <br />FIRE SPRINNLERS REO'D <br />FIRE ALAR'A REQD <br />p�ANS APPROVE� �Y <br />DATE <br />FEE <br />CONTALT PERSON AND PHONE N0. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIhED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PAOVISIONS OF LAWS AND ORDINANCES GOVE(iNING 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 IOCAL 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 LAW 1827 RCW AND 296.200 WAC. <br />x n,�-S �s , Ow�e2 �l'o�?'9Y <br />or*E <br />SIGNAiURE <br />N0. TYPEOFE�UIPMENT I FEE <br />FORCED AIF SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CI OTHES DRYE-RS _ <br />RANGEHOOD <br />WATER HEATE <br />FIREPLACE INSEFT <br />HEAT PUtitP <br />GAS PIPING <br />SUB <br />$ <br />5 <br />FEE PECEIPTNO. <br />PIJ�N CHECK NUMBER <br />u�laa9 . <br />fACANT SITE rcw <br />❑ YES � N� BUILDING <br />acuPnxcr xo ovowEuiucuxirs <br />�A�P PLUMBING <br />BnSEb�EN7 MECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />n <br />� <br />� <br />