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APPLICATIC" t FOR CONSTRUCT'1N PERMIY � <br />TO BE COMPLETED IN BLACK INK—�PLEASE PRINT <br />HEATING SYSTEM: �] GAS ti;JELECTfiIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />f� DEMOL�TION f�COMBINATION i] BUILDING L] MECHANICAL ❑ PLUMBItvG ❑ SIGN <br />p�[q � ' �l/��ADDRESS 1/ �ITV / [�I ZIP >MONE <br />� A � 1 uY• �✓dn,...l /�er �"b.�..l A dUd�,�.r.� i.le�f�c9 �,.x�l �-34—.39�%'� <br />TEN�NT <br />ADDRE55 <br />qiDE51(iNER M�ILADDRESS <br />LITV <br />ZIP ' PHONE <br />PMONE <br />GENEflALCONTR�CTOR MRIL�DDRE55 CITV ZIP PHONE STFTELIGENSE• <br />� t,JN e�2_ <br />MECHANIC�ICONTRACTOR MAIIADDRE55 pTY 2�P PMONE STATELICENSE� <br />PLUAIBM(iCONTBACTOR MAIL ADDRESS CITY Z�F PHONE STATE LICENSE � <br />�R� �S� <br />WORN ANO SOUARE FWTAGE <br />f MR a� �fTM�i' <br />PRpPOSED USE OF 9UILDING <br />Ok P�� <br />LFGALDESCRIPTIONOFPROPERTY�S1HO+VNBELOW R�TTACHTWOCOPIES� <br />LOT—�— BLOLK Ll v ���`�T JF �JC� <br />PARCELTA%L�.NUMBER <br />N�4i.lIG� p.L��ODe� <br />CONSTRUCiIONLOANLENDER.ADDFE55.TELEPHONENUMBEP <br />FLCXIR <br />SINK <br />FOR OFFICE USE ONLY: <br />cwwrscia�cK REARSETBRCK <br />115E ZONE <br />TYPE 0� CDNST. <br />SRE OF BIDG. <br />OCWP�NCV L <br />REASOH <br />INTAKE BV <br />wA <br />PERMIT <br />TOTALF <br />LOT AREA <br />NO. OF STORIES <br />FIRE SPPINKLERS PEO'D <br />FIRE ALARM REO'D <br />PLANS <br />DATE <br />BY <br />$ <br />PERSON <br />� HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AL� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRAC S L1W 7827 R/CW� AND 296200 WAC. <br />r e �G./KJ� /`lYfrry'r�� U.f /-/'%i <br />S�GNATIIPE ��T� <br />N0, rv� oF eouir�+em <br />� A/C—A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. <br />� UNITHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />; VENTILATION FAN <br />RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />� METAL FIREPLACE (WOOD 8UF <br />; FIREPLACE INSERT <br />� HEAT PUMr' <br />' GAS PIPING <br />� EXHAUSTPAN <br />SIDE SETBACK � PLAN CHECK NUMBER <br />VACANi SRf f CCa <br />❑ YES ❑ NO BUILDING <br />acursvcr xo a. � ��x;uans <br />�"0°P PLUMBING <br />BnSErnENT MECHANICAL <br />❑ YES r NO <br />HEIGHTLIMITATION ADDITIONALPLANGHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAII CODE IS 3105 �TI1L <br />PERMIT <br />TOTALFEE <br />�X <br />n <br />�n <br />Oy <br />M <br />� <br />� <br />