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APPLICATIO►�'A FOR CONSTFidJGTi'�`LN PEI�MIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ( f��� <br />_ ��f � � <br />BUILDING DEPAHTMENT L <br />259-8810 <br />i I DEMOLITION ; i COMBINATION <br />OYJNER UQ.QY� ' IL�AODPESS <br />��' . �. � <br />TE AN MaILADDR S$ <br />� ` ��-Q .t���� <br />A HITECT OR DESIGNER r MAIL Ac�� 1ESS �� <br />W Vv�(' �� 11 ) <br />GENERALCO RFCTOR M�ILA�DIlESS �i <br />� <br />MECHANICALLONTRACTOR MAILAOORFvS <br />r- _ <br />PLUMPINGCOVTRACTOR MAILAOORESS <br />' I�CL S OF WOFN <br />NEW I I ADDITION I i ALTERATION <br />lnsd c�� /�2, 25l0 — o f <br />LEGAL OESCFIPTION OF PROPERTV (SHOWN BELOW OF <br />�p7 BLOCK OF <br />ADDRESS <br />„Cac <br />'PE OF <br />LAVATORY�WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />BACKFLOW <br />ROOF DRAI <br />SINK (SERV <br />HEATING SYSTEM: U GAS <br />�❑ <br />EUILDING ME4HF.N;CAL <br />CITV 21P PHONE <br />,. ��,`L ,� <br />��CITY � ZIP � PHONE <br />' � J /—L J / � �}�c.�J a� <br />CITV ZIP <br />� <br />CITY ZIP <br />r� <br />qTV 21P <br />. REPAIR �� � DEMOLITION <br />,n� I �ONTAcTPER <br />� � <br />;2i JGE- <br />OR ITEM <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />� �Pcrssslr� «Pa�ii 35' raa� � <br />USEZONE LOTAREA <br />'% 23, �17d <br />TYPEOFGONiS.AILOWABLE ttPfOfCONST. Cil <br />_� �� <br />SIZE OF BLOG. IJO. OF STOFIES <br />y;y� sP -r <br />3YG SFGe.z Z <br />OCCUPANCYLOAD FIRESPRNKLERS <br />/J A /Jo <br />RE450N FOR SPRINKLERS <br />INTAK[ BY PLANS APFPOVEO DV <br />/ � /Z� <br />E <br />� <br />I 1 PLUMBING ' ', SIGN <br />tiii �n�- � �v�/ <br />�� PMO E 'e � � /� ( L / ' <br />1 L lJ <br />PMONE STATELIGENSE> <br />.� n o�-�f�-e h � 37 D.� <br />PHONE STATE LICENSE Y <br />�' <br />PHONE STATE LICENS[ p <br />WOODSTOVE/FRPL INSERT �'� �: BUILDING RELOCATION <br />����� 2 a U- `� �(� °1 <br />� I HEREBY CERTIFY THAT I HAVE RtAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />COPIES� 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 PRESi1ME TO GIVE <br />j AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />L�� OTHER STATE OR LOCAL LAW REGULATING CONSTP.UCTION OR THE <br />PFRFORMANCE OF CONSTFiUCTICN. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />AFPLICA'iION I MADE AND I COMPLY WITH THE STATE <br />CONTRACTO L 1827 RG'W AND 296200 WAC. <br />X � . 1D�21. � <br />,n:rinnwe onr[ <br />CP71 <br />FORCED AIR SYSTI <br />UNIT HEATERS—B. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />FANGEHOOD <br />WATER HEATER <br />GAS PIPIP <br />EXHAUST <br />SIOE SETBALN PLAN CM K NUMBEF <br />s' 9 2 � � <br />vncnNi siie FEES <br />BUILDING <br />aavprvcv noarowrwriourms <br />caouv pLUMBING <br />�-3 Z <br />BASEMENT MECHANICAL <br />HEIGHT UTAITATION ADDITIONAL PLAN CHcCK <br />� �� <br />G SPRINKLER <br />STATE BWLDING SURCHARGE <br />CITY Of EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />EOUIPMENT <br />f5—H.P. <br />_MS—B.T.U. M E.A. <br />8 <br />FEE <br />SUB TOTAL 5 <br />PERIAIT $ <br />TO'ALFEE S <br />�SY• 3 �-� <br />PECEIPT N0. <br />'!�, �s" 1 `�77D: <br />i <br />� �'J iOG <br />T <br />�� i�� <br />