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APPLICATIO'� FOR CONSTRUCTI"�N PERMIT � <br />TQ BE COMPLETED �N BLACK INK—PLEASE PRINT <br />• HEATING SYSTEM: ❑ GAS LECTRIC O <br />BUILDING DEPARTMENT ' <br />259-8810 <br />❑ DEINOLITION � COMBINATION ❑ BUILDING ❑ MECMANICAL ❑ PLUMBIN(3 ❑ SIGN <br />pyyryEq M�IL 11DDRESS CITV ZIP PIIONE <br />]-erri l�u�in�i�„ 2�/i� !�{;sti/a.tiQ aF�� �uer�.+F fB.zo/ �,S`2-z8� o _ <br />TF MAIL/�DORESS CITV ZIP PIIONE <br />IIRCHIiECTORDESIGNER M�M1ADDRE55 CITY ZIP PNONE <br />OENERILLCONTMCTOR MMIADDRESS CITY 2IP PMONE STATELICENSE� <br />�CH�N�CkC�Tq��TpR MAILAODPESS CITV 21P PMONE STATEIICENSE� <br />p�U,gWp�pNTMCTOR M�ILADDflE55 CITV 21P PHONE STATELICENSEI <br />CONTRACT PRICE OF WORK <br />pE$CRIBE WORK ANO SIXIARE <br />�CfP po <br />� PROPOSED USE OF BUKDINO <br />�D. <br />LEOAL OEBCRIPTKII OF P110PI <br />LOT �� <br />PAtICEI TA% I.D. NIIMBEfl <br />FOOTA(3E INVOLVED <br />CONBIRUCTION LWN IENDER. ADd1E55. <br />DRINKIN(i FOUNTAIN <br />FLOOR DRAIN <br />HACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />USEZONE <br />rvrE m mxsT. <br />SIZE OF BlIX3. <br />OCCUPANCVLWID <br />RE�SON <br />INTANE BV <br />CONTACT PERSON AND PHONE NO. <br />'�� <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />'n APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />S F Y` PROVISIONS OF LAWS AND ORDINANCES OOVERNIN6 THIS TYPE OF <br />lOWd1ATf�CNTNOCOPIE51 WORK WILL BE COMPLETED WITH NMETHER SPECIFlED HEREIN OR <br />NOT. THE dRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL UW REGULATIN(i CONSTAUCTION OR THE <br />PERPORMANCE OF CONS7AUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 2a6R00 WAC. <br />PERMIT <br />TOTAL FEE <br />LOT �REA <br />rw. oF sronies <br />FIPE SPRINKLERS REOV <br />FIRE �LARM flE0'D <br />PLANS APPROVED BV <br />DATE <br />... _i _. -'___ __ <br />SIDE <br />VACANT SITE <br />❑ YES ❑ NO <br />acuw�cr xoaowtwxcuxirs <br />GRWP <br />❑ YES I� NO <br />EVERETT <br />.SALES <br />iE IS 3105 <br />UNIT HEATERS—B. <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE <br />HEAT PUMP <br />BUILDING <br />PLUMBING <br />MECHANICAI <br />AODITION�L PLAN CHECK <br />OTHER <br />STATE BU�LDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />i <br />� <br />�y <br />N <br />❑ <br />