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�,. APPLICATIQ"� FOFi CONSTRUCT�N PERMIT � <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: ❑ GnS ❑ ELECTRIC ��ilLc-= S'J�T�I K/_ �- � <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f� MECHANICAL PLUMBING ❑ SIGN <br />OIYNEF MAIL DRE55 CITV , ZIP PHONE <br />�UnSI� i rz. ���rnac �D 13�x /�� �i �ohnrni�c UJ� �i I'a 9U <br />TENANT MAILADOFIESS CITY ZIP PMONE <br />ARCHIiECTORDE5IGNEH MFILAO�RESS CITV ZIP PHONE <br />GENERALLONTRACTOR MAILAD�flESS CIiY ZIP PHONE S�ATELILENSE� <br />LJ:\P <br />CONTRALT PRICE OF WOHK <br />OESCRIBE WORK AND SJiIAfiE FOOTqGE INVOLVED <br />PPOPOSED USE OF BUILOING / / �� <br />% /V� <br />LeGAL DESCPIPTION OF PROPERN �SHOWN BELOW OR A1 L�CH TWO COPIES� <br />LOT BLOCK OF <br />PARGELTA%I.D.NUMBER <br />CONSTFiUCTION LOAN LENOER. ADDRESS. TELEPNONE NUMBER <br />NO. <br />�a— %��GGGC� 5 ��. <br />FI%TURE OR ITEM <br />WATER CI <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />OISHWASHER _ <br />LtiUNDRY TRAY <br />CLOTHE5 WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLbOR DRAIN <br />S�IJK <br />FOR OFFICE USE ONLY: <br />FRCNTSEiBACK REARSETURCN <br />USEZONE LOTAREA <br />TYPE OF CONSi. <br />� <br />SIZE OF BLOG. <br />REASON I3iVi%'� <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE S <br />FIRE SPRINKLERS REO'D <br />�� <br />FIFlE A41RA1 REO'D <br />PLANS APFROVED BY <br />DA7t "7� /�7 <br />CITY <br />� . <br />CONTACT PEFSON ANO PHONE NO. <br />S��TAT�E /LIICENSE a <br />%U /"f'�% JU <br />STATE LICENSE k <br />I HERF.BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME i� BE TRUE AND CORRECT. ALL <br />NROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COPAPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CAIVCEL THE PROVISIONS OF ANY <br />OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFONMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWN[R OF THIS PHOPERTV TO PERFORM THE WORK �OR WHICH <br />APP ICA � N IS MADE �1 COMPLV WITH THE STATE <br />CON RA TORS LAW 18.27 RCW A D 296.200 WAC. <br />/ �� (� � C� c� 9 <br />S�GNAiUNE DAiE <br />CIiYBUSWE'iSLIC 5[NO <br />A/C—A/HNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br />UPJIT HEATERS—B.T.U. M � <br />--�— <br />CLOTHES DRYERS ' <br />VENTILATION FAN � <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSEFT � <br />T <br />HEAT PUMP ' <br />GAS PIPING � <br />EXHAUSTFAN __�_ <br />��/� /.�� <br />VACAkT SITE FEES <br />❑ YES ❑ NO BUILDING <br />acneecr xc.orow;uixawms <br />saour / pLUMBING <br />3 <br />BASEMENT McCHANICAL <br />❑ YES iG NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER ���/ <br />STA7E BUIC�ING SURCHARGE <br />CITY OF EVERETT auauc woaKs <br />LOCALSALES <br />TAX CODE IS 3705 TOTAL <br />TOTAL $ <br />NIT 5 <br />\L FEE 3 <br />