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APPd,�C/AT10"'� FOR CONSTRUCT[`�N PERIV�6T ; �' <br />TrJ BE COMPLETED IN BLACK INK—PLEASE PRINT ��,�`i�r <br />BUILDING DEPARTM[NT <br />259-9810 <br />❑ COMBINATION <br />HEATIMG SYSTEM: J GAS ❑ ELECTRIC ❑ <br />! I BUILDING f i MECHANICAL <br />CITV ZIP PHONE <br />EE,f'�T ���/1% � 3� <br />CITY ZIP punuc <br />J PLUMBING <br />��,� <br />nHCNI1cGTORpESIGNER MAILAO�qE55 QiV <br />ZIP PHONe <br />GENCRFLCONi3qCi0R MA!LADDRE55 CITV IIP PHONE STATEUCENSER <br />MECMANICALCONiRqCTOR MAILAODRE°5 ��ry Z�P <br />PMONE STATE LICENSE e <br />PWMBINGWNTRACTOP MAILADORE55 CIn• ZIP <br />PMONE SiAiE UCEN$EJ <br />C SIGN <br />CONiRPCT PRICE OF WORK � <br />�ESCRIBE WOflK FND SOUARE FOOT�GE INVOWED GONTACT PEFSON AND PHONE NO <br />i� t/Yfn i_ i c. / I f n iJ n �� n n.�_ r/ — <br />PROPOSEDUSEOFBpIL�ING i HER[BY CEFTIFY TF:AT I HAVE READ qND EXAMIN';D THI� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />/�/� �� " '� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGFLDESCRIPTIONOPPROPERTY�SH wrvee�owoannncHrwocowes� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br />�oxC'�L�'±��— g�p�g l9l oF P�,�+j �F ��y.c,�� �j T NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />��'�'` ��� �,{ AUTHCIRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />�1..vt�.1L1Y.�APC�f,�QD/Nl TO G��R� Ty�� OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I A;�1 AUTHU912ED BY THE <br />�-7 OF fJ?S � � y OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />PFRCELTARI�.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�j L� —�Y�CJ ��a �� �f�� � CONTRACTORS LAW 1827 RC W AND 296200 WAC. <br />CONSTflU1:TI0N LOAN �EN�ER, AU�R�ES�S. TEIEPHONE NUMBER <br />�'��UL�s_�Cll���_{;J � // =�`�/—� <br />PROJECT ADDRESS sicmn,unc <br />2!!.fl / �/n...r � ,. /_ i_ _ ..,.� .....a _ , ocis <br />OR <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFL01h' PP.EVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK BERVICE—BAR. E i C.� <br />FOR OFFICE USE ONLY: <br />FAONTSETBACN REARSET�ACK <br />USEZONE LOTAqEA <br />iVPE OF CON9L NO O� STORIES <br />� <br />S�ZE OF BIDG. FIRE SPqINKI.ERS REO'D <br />JCCUPANCI' LO�D FIRE ALFBM REO'D <br />INTRKEBY I PUNSAPPROVEDBY <br />onre <br />)TAL S <br />f $ <br />FEE 5 <br />0 <br />NO• TYPE OF ECIIPMENT <br />AiC—AiHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS--E.T U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOODS70VE <br />METAL FIREPLACE (WOOD BURNINC <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPIN3 <br />EXHAUST FP.N <br />S��E SEf�ACK P�qN CNE N NUMB[R <br />� c 3�3 <br />vncnNr sire FEES <br />�i YES .-� NO - <br />�UILUING <br />acuc��ucr �muru,vnuxcuvns <br />ca uo <br />PLUMBING <br />BAS MENT MECHANICAL <br />� i YES ❑ NO _ <br />iEIGHTLIMRATION ADDITIONALPLANCHECN <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT FUBUC WORKE <br />LOCAL SALES — <br />TAX CODEIS 3105 Torni <br />FF.E <br />SUB TOTAL g <br />FERMIT S <br />TOiAL FEE $ <br />RECEIPi NO <br />VALUATION FEE <br />i <br />1 <br />i <br />i <br />u <br />