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APPLICA,TI�,.�1 ��OR �OFIISTRUC7 _JN PERMIT � <br />TO BE COMPL.E'fED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: ❑ GAS ❑ ELECTRIC �J <br />25S-8810 <br />I! DEMOLITION I COMBINATION � BUILDING MECHANICAL ir' pLUMBING '' SIGN <br />OWNER IAAILAUDRESS CITY 21P PHONE �_6.n0-��j` <br />�ul1 � 5u -� FF.�� �,-: 4nn Faz� S�. M�u_+'�3�� �OA10Lc'Cc� NT 9�5/3 S�c� <br />TENFNT MAILA�DRESS CITV ZIP PHONE <br />��'1--.A) ! V�CJ .�1T c� hG F <br />ARCMRECTORUESIGNER MAILADOflESS qTV 21P PHONE <br />,,/ GENERALCONTRACTOR MAILADORESS CITV ZIP PMONE STFTELICENS[N <br />'1 �//r� r5 Mo� �� CnNsr 3/O 6 ,'.� � i-`` fi v� ,J.� . L,e. S j£'✓F�L: 33�--oS7�- L'N.z6ne i,o�g <br />pA� AIECHANICALCONTPACTOR �MAILAD�flE55 CITV 21P PNONE STATEUCENSEa <br />�1 _ _ <br />PL/U�'MBINGCONTRACTOR MAILADORESS CIN ZIP PMONE ST�TELICENSEk <br />l�,fil%IS MO�LF� C".niJiT�UC_Ti.Y.•,• <br />CLASS OF WOFN <br />CI NEW L J ADDITION I]C ALTERATION i� REPAIR � I DEMOLITION �. '�. 1NOOD5iOVEiFRPL INSERT ��. I BUILDING RELOCATICN <br />CONTRACT PRICE OF WORN <br />DESCFIBE WOflK AND SQUARE FDOiAGE INVOLVED <br />PROPOSE� USE OF BUILDING <br />T�NAn7T _ <br />LEGAL DESGR;PTION OF PpOPERTV (SHOWN <br />LOT BLOGK <br />PLUMaING <br />�UF�Z.�TT <br />� UE�.r_-,�j' <br />CONTACT PERSON AND PHONE NO. <br />i HEREBY CERTIFY THAT I HPVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THC SAME TO BE TRUE AND CORRECT. ALL <br />LOWOR�TTACHFOURCOP'ES) PROVISIONS OF LAWS AND ORDIIJANCES GQ':L"RNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PER�v11T DOES NOT PRES�IAIE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGU� �' ;•NG CONSTRUCTION OR THE <br />PERFORRiANCE OF CONSTRUC�f�Qn. � iihT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO �'fF�pRld THE WORK FOR WHICH <br />— APPLICATION IS MADE AND ' COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AN� 2962G0 WAC. <br />TYPE OF FIXTURE OR ITEM <br />BATH'fU8 <br />LAVATORY <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTAAY <br />CLOTHES WASHER <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW Pi <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSEiBACK <br />USE ZONE <br />TYPE OF CON�S. ALLOWABLE <br />1�1D GFY�� <br />SIZE OF BLDG. <br />OGCUPANCVLOAD <br />REASON FOR SPRINNLERS <br />INTAKE BY <br />LOT AREA <br />/� I 3 5- <br />PERMIT $ <br />TOTALFEE $ <br />SIDE SETBACK <br />VACANT SITE <br />7YPE OF CONSL �CTUAL <br />� OFSTORIES <br />FIRE R.'JKLERSFEO'D <br />w <br />PLANSAPPROVE�BV <br />r�iL;�91 dVV� <br />acuPaxcr uoo�owcwx.urvns <br />�Gaouv <br />BTSEMENT <br />HEIGHT LIMITATION <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />x l%i'1 •�w MOBc-�,� I G�- �s-4>- <br />scrvn*unE onrE <br />MECHANICAL <br />�,o <br />TYPE OF EOUIPMENT <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />P,ANGE HOO� <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIM <br />HEAT PUMP <br />GAS PIPING <br />PLAN CHECK NryUA <br />�� �D <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUIL�ING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />M E.A. <br />SUB TOTAL $ ' <br />PERMIT 5 <br />TOTAL FEE $ _ <br />FEE RECEIPTNO. <br />3� �'0 <br />a� <br />;�i <br />