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APPLICATIC'`� FOR CONSTRUCT' "�N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS i] ELECTRIC U <br />BUILDING DEPARTMENT �- <br />259-8810 <br />j(f DEMOLITION ❑ COMBINATION <br />p [q MRIL�DDRE55 <br />/��D �4lpa+Le 11i�/ <br />T NANT MAIL ADDRESS <br />����wr <br />ARGNITECTORDESIGNER MAILADDRiSS <br />,�G NER�LCONTPACTOR M�ILADORESS <br />(llft�lw�+►N dflATaaf iwy <br />uFCHANICRLC TRACTOR MAIIADDRE <br />ADDRESS <br />❑ BUILDING <br />CITY <br />r� ��s�6 � <br />CITV <br />LI MECHANICAL <br />21P l PHONE <br />' y ��J %`.fb/ <br />ZIP °HONE <br />CITY ZIP <br />! .rl�'�Yiw� � <br />CITY Z�P <br />CITV ZIP <br />PNONE <br />i-1 PLUMBING ❑ SIGN <br />�� w <br />'�ZGb'�� � sdfl <br />STATE LICENSE 11 <br />bt.7`l/�e. �+� <br />SiPIE LICENSE f <br />✓MS<i�� /� <br />STATE UCENSE I <br />CONTR�CT PRICE OF WORIf N� <br />OESCRIBE WORK AND SOU/NE FOOTAGE INVOLVED CONTACT PERSON ANO PMONE N �!�/ � T <br />� <br />� 333-���� <br />1 � � HEREBY CcRTIFY THAT I HAVE FEAD ANO EXAMINED THIS <br />PROPOSED USE OF �UILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND I:ORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGALDFSCRIPTIONOFPROPERTY�SHOWNBELOWOPATTACMTVOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />� � ��� � L�) � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />�pT d� BLOCN oF � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />X '�T ` /2,�9 .� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />f■� - PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />3��� �� _ Q,Z 8�DOO ji OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TA%1.0. NUMCEH CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />� 6 7rHIGli/✓ /� /i�„[� � <br />CONSTR IONIOANLENDER.pDDRE55,TELEPNONENUMBER �u/JZ /�� <br />%�COcuavle �� <br />�F FIXTURE OR ITEM <br />WATER <br />SHOWER <br />KITCHEN SINK 8 <br />CLOTHES WASHER <br />URINAL <br />PREVENTERS <br />�INK <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />FRONTSETBALK REpRSETBACK <br />USE ZONE LOT AREA <br />7YPE Of CONSf. N0. OF STORIES <br />S2E OF BLW. FlRE SPRINKlERS REO'D <br />.�.��uoeuev i nno FIRE ALARM PEO'� <br />INTANF �Y <br />ORTE <br />0 <br />$ <br />SIDE SETOAGK <br />OF <br />FORCED AIR SYSI <br />UNIT HEATERS—e <br />CLOTHES DRYER; <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLAC <br />FIREPLACE INSEF <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />f�l YES n NO BUILDING <br />p[(pPMCY NOIXOWRUNf•UNpS <br />�^W^ pLUMBWG <br />BASEMENi . MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMIiAT10N ADDITIONAL PLAN CHECK <br />OTHER <br />STATE OUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL S11LES <br />TAX CODE IS 3105 T�TRL <br />M <br />E.A. <br />PERMIT S <br />TOTAL FEE S <br />FEE <br />—T <br />NO. <br />X <br />�tl <br />N <br />• <br />