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APPLICATIC'�1 FOR CONSTRUCT'�lN PERMIT ��� <br />^ TO Bl: COMPLETED IN BLACK INK—PLEASE PRINT <br />�� I LHEATING SYSTEM: ❑ GAS ❑ ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />nGnnni iTinN � COMBINATION iJ BUILDING f4h.ECHANICAL !! PLUMBING 1 SIGN <br />ua�r�.0 <br />ARCHRECTOR <br />IdqIL <br />MAIL <br />CRV uY <br />Si-' tU�C��Tl� `�.�' <br />CITY Z�P <br />GTY Z�P <br />PMONE <br />PHONE <br />GEN[RALCONTFACTOB MNILAODRE55 CITY ZIP PHONE STAiELICENSE> <br />�U,Ce�,� CONc�P-,�. l9?2i 6�h� � �YN�U�✓l gd036 7�1:��)r �v,e��cL/rocaN <br />IdECHANICALCONTRAGTOH Id41L�DORESS <br />C�TY ZIP PHONE STATE UCENSE a <br />PLUMBING GONTR4CTOR MAIL AD�PE55 CITV 21F PHOY[ SiATE UCENSE x <br />�ONTRACT PqICE OF WORK <br />��mv. - <br />DESCFIBE WORKAND SOUqRE FOOiPGE INVOLVED <br />(� 0 _ �2LA'h��.�:. �f� L�...1 <br />0 <br />n . i r i <br />PROPOSED'USE OF BUILOING <br />LEGAL �ESCflIPTION OF PFOPERN �5110WN BELOW OF ATTAGH TWO COPIES� <br />LOT BLOGK �F — <br />PARCELTA%I.p.NU1d6EF <br />CONSTRUCTION LOAN LENOER. <br />OF <br />WATER CL <br />BATHTUB <br />LAVATORY <br />SI�K 8 DISP <br />LAUNDRYTFA <br />CLOTHES WA; <br />URINAL <br />JRINKING FOl <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRONISFTBACK REARSETBACK <br />USEZONE <br />lY?E Of WNSi. <br />size oF eioc <br />OGCUPANGYI <br />PEPSON <br />INTAHE BV <br />NUMBER <br />CONTACT PERSON Atl� PHONE NO. <br />i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AIJD I:NOW THE SAME TO bE TRUE AND CORRECT. ALL <br />PFOVISIONS OF LAWS AND ORUINi�i10ES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPeGIrIcD HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO CIVE <br />AUTHORITY T�J VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION CR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I A�d AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPI.ICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT.:ACTORS LAW 182�W AND 296.200 WAC. <br />� / y'/ <br />�{ri /� /���1 __ <br />SIGNAiUF[ O4iC <br />FEE NO. TYPE OF E�UIPMENT <br />AIC—A/HNDLG UNITS—H.P. <br />� �� I FORCED AIR SYSTEIdS—B.T.U. M <br />� ��I UNIT HEATERS—B.T.U. M <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 3 <br />SID'c SEtBACK <br />LOT AREA <br />NO. OF STORIES <br />FIFE SPRINNLERS REO'D <br />FIRE ALARM1I REOD <br />PLANS APPFOVED b1 <br />DATE <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE <br />'PUMP <br />PIPING <br />4UST FAN <br />V�CANT SITE rc�o <br />_� YES �,-. NO BUILDING <br />nxu=>::� uo o: r,r:snncusas � <br />�°�0" PLUMBING <br />BASEMENT ��ECHANICAL <br />❑ YES NO <br />HEIGNiLIAfITAiION ADDITIONALPLAfICHECK <br />OTHEF <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />FEE <br />SUB TOTAL <br />PEFiAt1T <br />TOTAL FEE <br />8 <br />0 <br />