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APPLOCATIC"1 FOR CONSTRUCT`"1N PERMIT � <br />TO BE COIAPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC_�] <br />259-8810 � <br />❑ DEMOLiTION IJ COMBINATION LN' BUILDING ! l MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER l.IAIL��ORESS CITV ZIP PHONE <br />��11GL/F�!`l Yl' 1`11�C f"I1: LL '/��� p'bf/i<I>P..L�;i `�`>Z. � 7�;G >%S-/S%j <br />TENANT MFILApGRESS qTV ZIP PHOKE <br />ARCIIITEC'JROESIGNEfl AIFILADDRESS <br />GENE�QNTRACTOF MAILADD9ES5 <br />�I.LI /l4� <br />MEL IGFLCONTRACTOR MAILA7DFE55 <br />PLUMBINGCONTRFCTOR I.IAILADDRESS <br />CONTRACT P E OF WORI: <br />�GI. �CO� .�- <br />�ESCRIBE WOflK AND SOVARE FOOTAGE <br />��r„��.,-�Qe� �� � <br />��/ �cv^A- . <br />FPOPOSED USE OF BUIL�ING <br />LEGAL OESCCiIPiION OF PROPE <br />LOT BLOCN <br />P.\RCELiA%ID.NUMBER <br />(SHOWN BELOW OR ARACH TWO GOPIE^.� <br />OF — <br />CONSTRUCTION LOAN LENDER, ADDRE55. iELEPHONE NUM1I9ER <br />PROJECTADDRE&' <br />i335 2� <br />PLUMBING <br />O. TVPE OF FIXTURE OR ITEM <br />LAVATORY (WASii BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />GLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF <br />SINK ( <br />SUB TOTAL 5 <br />PERMIT $ <br />� TOTALFEE 5 <br />FOp OFFICE USE ONLY: •v2� LSt� <br />, <br />F�, . � eT�ACK pH r�(iS�T9ACK� <br />1 T. _j- 7`Il. <br />ZC'� �l�` � -( GN -i 'i7 <br />USEZONE LOTAp�EAj,�� � <br />' �� "/N �- <br />r.�rarr.nusr r+o.oFsroaiEs <br />SIZE OF OLOG. <br />I�1�8 SE E <br />OCCUPA�L''— <br />REASON <br />INTANE BY <br />FIflE SPPINKLERS REO'D <br />�(U <br />FIRE ALARM flE0'0 <br />-� � -- <br />PLANS APPR�BV <br />DnTE D� �. /c : <br />CITY ZIP pHONE <br />C17V <br />:TY <br />za 3 <br />FEE <br />'�1'� � 17 <br />STATE IICENSE A <br />ZIP PHONE STATE IICENSE a <br />ZIP PHONE STATE LICENSE n <br />- �`/•S-/S ��/ <br />I HEREBY 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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCE� THE FROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUGTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br />APPLICATIUN IS MADE AND i COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANLt 296.200 WAC. <br />X l-� �C ���� ��- l�t�«o,� 5- z Z-�� 3 <br />s�.crvniune ' onr[ <br />N0. TVPE OF E�UIPMENT <br />A/C—A/HNDLG UIJITS—H.P. <br />FJRCED AIR SYSTEMS—B.T.U. "A E.A. <br />UNIT HEATEFS--B.T.U. M <br />CLOTHES DRYERS ! <br />�i� VENTILATION FAN <br />J_ RANGE HOOD � <br />WATER HEATER <br />METALf�IREPLACE� <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN ) <br />SUBTOTAL <br />AERMIT <br />TOTAL FEE <br />>> / o „25a .�3 <br />NUMBER FEE . _ „ _i <br />Np�lCaN�UC�qir�6 Qr,3 � <br />VACFNT SITE FEE$ <br />❑ YES �CNO BUILDING <br />acevauc� uoovmveun;cwi,�s <br />��y/Fc�.�o ' pLUA181NG <br />L� <br />oaSEM�E i MECHANICAL <br />!�lES ❑ NO <br />HEIGHTUMIT�TION AD�ITIONAL PLAN CFIECK <br />7� ' <br />O7H[R <br />S7ATE BUILDING SUPCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LQCAL SALES <br />TAX CODE IS 3105 TOTAL <br />S <br />4 <br />i <br />; <br />T <br />