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APPLICATIC�I FOR CONSTRUCT"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—F+LEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT — <br />259-6810 <br />❑ DEMOLITION ❑ COMBINATION Gf BUILDING ❑ MECHANICAL ❑ PLUMBlNG ❑ SIGN <br />OWNER MAILADORE55 CITY ZIP PHONE <br />1'�lLe{ti�.D IYbG1--�(�oX Co3'o �1fAiGN�d�- Fz' l�� 9��1 3S 3- <br />� �L <br />TENANT MAILApDRESS CITV 21! PHONE <br />AflCHITEGT OR OESIGNER MAIL ADOFESS GTY 21P PHONE <br />GENERALGCNTBRCTOR MAILADORESS CITV ZIF PHONE STATE'ICENSE� <br />(��I'� r p°.10 �$`1-7Z� R1f�rz.Cc.c�ZNS <br />� ylWlL`�F� ��51 �� �� ��O �UY,`� Z�p � pHONE 57ATEUCENSE£ <br />MECMnNICALCONTPACTOR MAILADDRE55 <br />PLLIAIBINGCONTRACTOF MAILAODFESi CITV 21P PHONE $TATELICENSE� <br />GONTRACT PRIGE OF WORK ' %/ /_ i( � <br />9 4uv �° <br />UESCFIBE WUPK AND SOUARE FOOTA E INVOLVED CONiACT PERSON AN� PHONE NO. <br />_ _ -� -stl 1L7S2 <br />PROPOSE� USE OF BUILDING <br />�RRv� <br />LEGAL OESCRrIPTION Of PROPE <br />LOT—+�-�-- BIOCK <br />PAflCLL A%ID.NUMBER <br />�� <br />CONSTRUCTION LOPN LEI <br />_ �5�/-7zSo 3afl �°7'7`% <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 NPE OF <br />(SHOWNOELOWORATTACHiWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />��h.� d�. NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�+ I7 �LMku �GY+�� C�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 18.27 RCW AND 296.2Q0 WAC. <br />1 ESS,TELEPMONENIIMBEP. �—�7 n FJnnVQI/� �3 (�% <br />��1�]�/ ��xJw--- 1 <br />SIGNALOP[ DAl[ <br />NO. 7 rrn vr nw i� <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />SUBTOTAL $ <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR� <br />1 <br />NPE 0�-�7� � <br />_.Yl�/ <br />SREOFBI�G <br />REASON <br />INTANE �V <br />LOTAREA <br />v�o <br />PIRE SPRiNHLERS FEO� <br />FIRE ALF�OREOD <br />�V <br />JI� <br />DATE � <br />av <br />FEE M0. � TYPE <br />UNIT HEATERS—B.T.U. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />1NOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN: <br />F'EAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLFN <br />VACPNT SITE / • <br />❑ YES Y N� BUILDING <br />OUOveNC� ��OOi�WEiI�ILUNitS <br />��3�ur � p' PLUMBING <br />M �� <br />BASEMEr�T MECHANICAL <br />❑ YES X,NO <br />HEtGNT UMRATION <br />ADDITIONAL PLAN CHECK <br />�I I O7H[R <br />STATE BUII.DING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />T.U. M <br />BURNING) <br />SUB <br />73 <br />_� <br />u <br />