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A�PLICATIQ ; FO� CONSTRU�T. )N PERMIT ���� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT ' <br />259-8810 <br />I i DEMOLITION ! I COMBINATION <br />OWNER MAIIADDRE55 <br />y'JA1s{fl/�E�Mf�'��'. '�G�ir � <br />iUOnJE <br />ARCHITECTORDESIGNEF MAILADDRESS <br />� � <br />GENEFAL LONTRACTOF IdAIL AODRESS <br />�DnrSf1:ti16_ /�,lirrF S'NG <br />HEATING SYSTEM: � <br />(iSUILDING <br />CITV <br />�l <br />i '�, p,DD1710N '�. � ALTERATION ! ! REPAIR <br />IEOFWORK �S.LN� INaT —`�%l <br />_( <br />PROPOSED USE Of BUILOING <br />_S/NG,�E ��9�-r���-/ ,�s`, <br />LEGAL DESCRIPTION OF PROPERiV �SHpµ�N B W W OR ATTACH F <br />LOT�_ BLOCK OF� <br />� v'i'�� 3 � �EC. _ <br />_� L l�.3 00o fo2 1 <br />PLUM8ING <br />O. TYPE OF FIXTURE OR lTEM <br />�WATER CLOSET (TOILETI � <br />SHOWER <br />KITCHEN SIN{<& DISP <br />UlSHWASHER <br />LAUNDRY TRA': <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SUBSUTAL 5 <br />PERMIT $ <br />TOTAL FEE $ <br />❑ ELECTRIC ❑ <br />!i'IIfECHANICAL I�PLUMBING <br />ZIP PMONE <br />�Li2�3/ 334—ZGuu <br />ZIP <br />� <br />ZIP <br />L <br />ZIP <br />PHONE <br />� <br />PHONE <br />�' <br />PHONE <br />STATE IICENSE a <br />>n15r( H " <br />STATE LIGENSE b <br />STATE UCENS[ a <br />' l SIGN <br />! DEMOLITION I���. WOODSTOVE/FRPL INSERT i I BUILDING fIELOCATION <br />� ICON/Tq/CT PEFSON FND PHONE NO. <br />{?� �%%f01 /Ail '?i�-._ %/1 '�7 /'1 <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAfl SFT�ACI: SI�E SETBA <br />�' �' s' <br />11SE ZONE l0T APEA VACANT SIT <br />� <br />iYPE OF CONTS. � <br />—IJ <br />SIZE OF BLDG. <br />INTANE BY <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPL ICATION AND KNObV THE SAME TO BE fRUE AND CORRECT. ALL <br />PRO'JISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOrIK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NGT. THG GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRVCTION OR THE <br />PERFCRMAN Of CONSTR ION. THAT I AM AUTHORIZED BY THE <br />OWNER OF IS PROPER O PERFORM THE WORK FOR WHICH <br />APPLIGATI N IS MAD AND I COMPLY WITH THE STATE <br />CONTRACT. RS LAW 18. CW AND 296.200 WAC. <br />1: <br />TYPE OF EOUIPMENT <br />JDLG UNITS—H.P. <br />41R SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE & CHiMNEY <br />FIREPLACEIMSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PL�N <br />_�vy %7 BUILDING <br />TYPEOF ONSTACTUAL UGCUGaIiCv I:OOfpWfLLlbGu4J5 <br />'A0°3 � PLUMBING <br />NO.OFSTORIES BASEMENT MECHANICAL <br />' G4Rn(;E � <br />IflE NLERSREO'D HEIGHTLIMITAT�ON A�DITIONALPLANCHECK <br />�L� S ' . SPRINKLER <br />� ,U.i�L�NY12S� �Y �/ � STATE BUILDING SUF?CHARGE <br />a�nr,s �Roveo ev CITY OF EVERETT PUBLIC WORKS <br />��Id g�3�/g3 LOCALSALES <br />TAX CD�E IS 3105 rorn� <br />FEEn /� <br />�/ �/ "5 �� <br />FEE <br />a <br />8 <br />