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APPI.I�ATIi�'''! FOR CONSTRUCTiI�DN PERIIAIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ � <br />BUILDIIJG DEPARTMENT <br />259-8810 <br />❑ DEMOLITION � COMBINATION ❑ BUII_DING <br />O NER n '1 MAIL DfiESS CIT/ <br />��d'o,�i,�o�c� C�.�-�v-� �row_�S <br />TENANT MAIL AOORE55 CITY <br />— 3 l o(, �15�'� (AU 1�Lc-. C-�T <br />ARCHITECT OP. DESIGNE <br />�v» V <-S C t <br />GENERA4pCO TRACTOR <br />��\ C`Ia+WOo c <br />P W M91NG CONTRACTON <br />lAAIL A�DRE� <br />locin, <br />MAIL <br />MAIL <br />cin <br />C �T <br />cin <br />an <br />CITY <br />GONTflAGT f91CP OF WORK � <br />� 0 � �0 � <br />DESGRIBE WOFK AND SOUARE FOOTAGE INVOLVED <br />� "3 �l S�v � <br />��e w C-�+, S�-vti� ����w. <br />PROPOSEDl1SE°�j 3UILUWG ! 1� <br />�LGSa `��i-�`_"� <br />LEGAL DESCP.IPTION OF PflOPERTV �SHOWN BELOW OR ATfACH TWO COPIES� <br />LOT—�+— BIOCH �F <br />�rtt72T _ pG+4 T �.�' 9c3 <br />PARCELTA%LD.NUMBEP <br />CONi�RIICTIQN LOAN LENDE,R. A�oRESS. TELSPu C E NIIM� � <br />�{- O.. . i . i d— <br />W <br />N�-7YPE OF FIXTURE OR ITEM <br />WATER CLOSE7 ( i ui�t i <br />BATHIU6 / <br />SINK & DISP <br />HER <br />'TRAY <br />URINAL <br />URINKING FOl <br />FLOOF CRAIN <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK� REAfl SET <br />ucc>nuc_ LOTAREA <br />TVPE <br />INTAKE <br />SUB TOTAL S <br />PERMIT i <br />TOTALFEE 5 <br />fIFE SPRINKLEF� REO'D <br />_1J ° <br />FIRE ALAFlA FEO'0 <br />A10 <br />PLANS A$1'�VED BY <br />Of.TE Iq /�Ji7/� <br />FEE <br />% <br />❑ MECHANICAL ❑ PLUMBING ❑ 51GN <br />Z�p PHONE <br />ZIP <br />��Zo <br />ZIP <br />`1�Zo( <br />ZIP <br />21P <br />� PHONE <br />3�—E --z� � � 3�(�;-SS`f4� <br />PHONE <br />�.�Z- �Zuo <br />PHONE STATELIGENSEN <br />���� E n � ty <br />PHONE ST�TE LICENSE a <br />PHONE STATE LICENS[ u <br />— 3`�'�9`t� <br />I HEFEBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br />APPLICATION AND hC10W THE SAME TO 9E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OR�INANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMF:.ETED WITH VJHETHER SPECIFIED fiEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISIOPlS OF ANY <br />OTHER S'(ATE OR LQCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE W09K FOR WHICH <br />A''PLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTG LAW 78.27 RCW AND 296200 WAC. <br />b � r �'���� <br />J�GNP iL � OAi� � <br />OF <br />FORCtD AIR SYSTEMS—B.T.U� � E_A• <br />UNIT HEATERS—B.T.U. M � � <br />CLOTHES DRYERS <br />VENTILATION FAN <br />� RANGEHOOD <br />� WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />� FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />�1_ EXHAUST FAN //// _ <br />❑ YES Cl NO BUILDING <br />acuvaxm xoc=ow¢mr+cmms <br />00.°3 ' PLUMBING <br />BnSEUENT MECHANICAL <br />❑ ves ��o <br />NEIGHTLIldiTATION ADDITIONALPLANCHECK <br />Z / OTHER '���[�/U <br />STATG BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIG WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL 5 � <br />PERMIT $ <br />TOTAL FEE S <br />FEE RE IP7.{Jj� -- <br />, 7 �7�'� !J�" / <br />VALUATION FEE � <br />69 050 �D�%;�a�J <br />__ � <br />i <br />n ., � <br />� <br />