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APPL,ICATIC -1 FOR CONSTRUCT" �Id <br />TC BE COMPLETED IN BLACK INK—PLEASE PRINT <br />PERMI7' �✓�" <br />f HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDi.NG DEPARTMENT <br />259-881 L` <br />C5 DEMOLI?ION Y COMBINATION f i BUILDING i MECHANICAL ❑ PLUMBING �] S�GN <br />OVJNER f.1AIL AD�RE55 QTY IIP PNONE <br />��n✓L�h��ry,,,iRof�f/�'fS �6(L HoyT L4�fR�iT G��l 9$k�i 339-zz�i3 <br />TENANi MAILAODRE55 CITV TIP PHONE <br />AriCM17EGT OR DESIGNER MAIL ADDFESS <br />LITV 21P PHONE <br />GENERAL CONTRACTOR 61pIL AD�flESS LITV ]IP PHONE STATE LICENSE s <br />N�1 �l�9�i. G� �Si 2 r 3 t N� cN Utr-o •9��t' c+x�/=;"T i.✓li 9 8�.o r z�(L -� 4 So N�?�/Sx.y- 2 300 /� <br />IAELNANICFLGONTRFCTOR MAILqDDRE55 GITV ' TIP PHONE STATEUCENS[x <br />PLNABMG CONTR0.CTOR AIAIL wOLFESS <br />CONTF4CT PFiICE OF WORK <br />DESCRIBE WORN AND SOUARE FOOTAGE INYOLVED <br />PROPOSED USE OF OWLOING <br />CITV ZIP <br />/[/. S/PEi-�c <br />LEGAL �ESCRIPTION OF PflpPERTV (SHOWN BELOLV OR ATTACH TWO COPIES� <br />LOi BLOCN OF N�• �� ' Q�' `J ��� <br />�c� oi' �oTs is �2y.�sb��a 3'oF <br />Go i 3v� 6�o�a 16`1 �/zn,�OVf� �1P0/�rar <br />PARCELTA%ID.NUMBER <br />CONSTRUCTION LOAN LENDER, I.DORESS, <br />GL'� <br />ADDRESS c� �y Hoy i <br />WATER CL <br />BATHTUB <br />LAVATORY <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />DRMKING FOUNTAI <br />FLOOR DRAIN <br />BACKFLOW PREVEI <br />ROOF DRAINS—RAI <br />OR ITEM <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />❑SE ZOIJ[ <br />TYPEOFGONSi. <br />SIZE OF BLUG. <br />OCCUP�NCYLOAO <br />REASON <br />RlTANE �Y <br />SUB TOTAL S <br />PERA4IT i <br />TOTALFEE 5 <br />L07 A��EA <br />hOAF STORIES <br />FIRE SPR�NKLEFS REQ'D <br />FIRE ALARM qE0'D <br />PLANS APPROVLD �Y <br />onre <br />SI�E SETOAGN <br />PHONE STATELICENSE> <br />CONTACT PEFSON FND PHONE H0. <br />L - <br />I HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED TliIS <br />APPLICATION AND KNONI THE SAME TQ BE TRUE AND COFiRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE CC�v1PLETED WITH WH�THER SPECIFIED HEREIN OR <br />h:1?. THE GRANTiN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUY40RITY TO VIOL�'TE OR CANCEL THE PROVISION> OF ANY <br />OTHER STATE OR LOCA:. LAW REGULATING CONSTRUCTIGN OR TH;� <br />PERFC�RMENCE OF CON; TRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPE.3TY TO PERFORM TI1E VJORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAR' 18.27 RCW ANU 296200 WAC. <br />X ��J—�%'+�/ � %��iW�'� �' 70 -% y <br />.,crarun nc, [ <br />cirvousinessuce�+semo '! <br />FEE NO. TYPE OF EOUIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE ; <br />METAL FIREPLA�E (WOOD BURNING) � <br />i FIREPLACE INSERT <br />—r HEAT PUMP <br />; GAS PIPING <br />�— EXHAUST FAN � <br />VALFNT SITE <br />� YES C! NO <br />aacervcr naorc:ve.o,cur�s <br />GNOOP <br />❑ YES ❑ NO <br />HEIGNT U�dRATION <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COQ: IS 3105 <br />PLAN CNECK N11G18EH <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHEH <br />57/ifE BUILDING SURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />SUB TOTAL � <br />PERMIT S <br />TOTALFEE S <br />F�E I AECEIPTNO <br />i <br />