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� <br />APPLICATI(-V FOR CONSTRUCT"'JN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />BUILDING DEPARTMENT HEAI'IiJG SYSTEM: 1i,4 GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION pQ COMBINATION ❑ BUILDING CI MECHANICAL ❑ PLUMBING ❑ SIGN <br />O ��R / / A �IAILADD��jA� �7V1l� G(/�FG�/ ��Z(/� PHONE � /C] -383�i <br />3�; <br />TENANI MAILAUOflE55 CITV ZIP PHONE <br />AFCHREGTOROESIGNEF IARILAD�RE55 CITY ZIP PNONE <br />Des�a� Ur�e �d�,e�n� 353-�.� I <br />GENERALC TRAGTOR MAILAOORE55 q � , GTV Z�P _ PHONE STATEIILEN5E1 <br />C <br />� <br />Z�P <br />� <br />ZIP <br />OF WORH <br />INVOLVE� <br />P SE�I�DING <br />1 <br />LEGRL DESCRIPTION OF PROPERTV �SHOWN BELOW <br />LOT V BLOCK OF <br />PARCELTAXID.NUMBER <br />CONSiRl1CTION IORN LEI <br />PLUMBING / <br />0. TYPE OF FD <br />WATER CLOSET (TC <br />BATHTUB <br />LAVATORY(WASHB <br />( SHOWER <br />KITCHEN SINK 8 DI; <br />/ DISHWASHER <br />LAUNDRYTRAY <br />/ CLOTHES WASHER <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR, ETC <br />CONTACT PERSON AND PHONE NO. <br />�E � 2. � <br />SIDT/�/y ICENS: � <br />� __L].Y�LI]� <br />STqTE LIGENSE M <br />�� <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />rnocoaies� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />�T ��,� NOT. THE GRANTING OF A PERMIT DOES NOl' PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />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 � COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />�//i/ ,, i ._ . 1/1Al 1nQG.n�—.�— /o—?5��9� <br />SUB TOTAL S <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRO�T SETBACK REAR SETBAGN <br />?�m � 2v ' <br />USE20 LOTAFEA <br />- I � 000 <br />IYFf Of LOIISi. NO.OF STORIES <br />SRE OF OIOG FIRE SPRI� ERS REO'D <br />2�55 SF t <br />G6o SF Gqrt <br />OCCUPANCY LOAO FIRE ALARM HEO'0 <br />N �a <br />REASON <br />INTANEBY PLANSAPPROVEDB`. <br />O�T��/. �� <br />FEE <br />0 <br />MECHANICAL <br />10. TYPE OF EOUIPMENT <br />FVC—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 HEATEA / <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUR�VING�(�{ <br />FIREPLACEINSERT <br />HEAT PUMP <br />2 GAS PIPING <br />SIDESE7BACK PLANGMt,1� M1�d,%�� <br />S ' ��� �Q <br />VACANi SITE FEES <br />�YES .-� NO BUILDING <br />anieaacr r�a�racEwvcc��rs �—�— <br />�aa" / PLUMBING <br />B�M Nr MECHAhICAL <br />❑ YES i✓NO <br />HEIGMiLIM_iTpTioy ADDITIONALPLANCHECK <br />L� OTHER � <br />STATE BUILUING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />� <br />� <br />� <br />SUB TOTAL 5 �_ <br />PERMIT 5 � <br />TOTAL FEE $ <br />FFr' , n L�� RECEI�J S� <br />y C! <br />VALUATION FEE <br />_L� (�a0 �7 ' ) <br />� <br />i <br />i <br />//� � <br />i <br />� <br />��� <br />i _ <br />�l n i <br />`// i, i — <br />