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APPLICATIC 1�OR GONSTRUCT 1N PERNIIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS FLECTRIC ❑ � <br />259-8810 <br />❑ DEMOLITiON ! COMBINATION !' BUILDING iXMECHANICAL f 1 PLUMBING Cl SlGN <br />Oy{tJ�ER IdAiLA�DRE55 CITV YIP PHONE \ <br />�X.�nr.� �f:.L'n� l"�.`a`1 mr:rinA:,r. �i..., S' �.Dn��1-4- GRan7� a�.t,71�'l\ <br />TEM1ANT <br />AflCHITECTOR�ESIGNEF M/.ILAUDPESS <br />CITV ZIP <br />GTV ZIP <br />PHONE <br />9NONE <br />GENERAICONTRACTOP MAILAOORESS CITV 21P PHONE STAT[LICEIlSEk <br />MECHANICAlC01liRACTOP MAILAODPE55 QTY ZIP PHONE uiATELIGENSEk <br />=CE \\ _ i�ER��Sn����H <br />PWMBINGCONTRACTOR MAILAOORE55 CITY ZIP FMONE STATELIGENSEM <br />OESCRIBE WOFH AND S�UFRE POOTAGE INVOLV2D <br />IEGAL DESCRIPTION OF PFOPERTY �SNOWN BEV`W CR FTTP.CH TWOCOPIES� <br />�or s�ocK oF — <br />PAFLELTA%ID.NOMBF.R <br />��NSTRUCTIONLOANLENDER.AOOFESS.TEL[PNOIJE <br />N0. I TYPE OF FIXTURE OR ITEM <br />i WP.TER CLOSET fT01LET) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PR[VENTERS <br />flOOF DRAINS—RAINLEADERS <br />FOR OFFICE iJSF ONLY: <br />FRONTSE7BAGK RE4RSE�BACN <br />7VPE OF CONSi. <br />SREOFBLDG. <br />OCCUPANf,YLOAD <br />REASON <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE 5 <br />-� SIDESETBALK <br />LOT AREA <br />NO. OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIRE ALARld REO D <br />PLANS APPROVEO BY <br />DATE <br />� <br />❑ vEs � No <br />ocmva,cr nooro�rvuw�cusrts <br />GFOLP <br />B�SEMENT <br />I- YES ❑ NO <br />HEIGMT LIMITATIOt� <br />CITY OF EVERETT <br />IOCAL SALES <br />TAX CODE IS 3105 <br />CONiFCTPERSON <br />I HERcBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN � THIS TYPE OF <br />WOPK WILL BE COMPLETED WI7H WHETHER SPECIFItD HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NUT PRESUMF TO GIVE <br />AU'HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHEfi STATE 6R LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEPFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.27 RCW ANO 296.20D WAC. <br /><i�vr*un[r��� � nr���1�-- <br />CIfV DIISMF55 UL[NSF. NO <br />A/�A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />RANGEHOOD <br />WA'i ER HEATER <br />4YOOD STCVE <br />METALFIREPLACE� <br />FIREPLACEINSERT <br />PI.AN CMECK NNABER <br />euuowc <br />PLUMBING <br />MECHANICAL <br />ADOITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TOTAL <br />FEE I RECEIPT N0. <br />AM <br />e <br />0 <br />