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x <br />e <br />APPLICATI�'�1 FOR CONSTRUCT��9N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILUING CEPARTMENT HEATING SYSTEM: ❑ GAS �LECTRIC ❑ <br />259-8610 <br />Ci DEMOLITION ❑ COMBINATION �UILDING I_ i MECHANICAL PLUMBING Cl SIGN <br />OWNER �%'�ZJ � ��,�,� 3 lAAILADDRE55 GTY ZIP pHONE <br />/l%..I.n P�A ��N- � 3Gnl C�LG� F„ere Fi 9B7o1 �, I-5no <br />TENANi M411.AD�RE55 CITV ZIP PMONE <br />ARCNRECTORDESIGNER MAILADDRESS �ITY ZIP <br />.�� a�� i ..,.� � [_Zereu ioCW C.J7'7[vU /�//t�lHHCfO�[[� <br />GENERALCONTRACTOq M1IAILADDRES$ CITV ZIP PNONE STATEUCFNSE� <br />MECHANICpLCONTRACTOR MAILADDRE55 CIT1' ZIP FMO : $TATEUCENSER <br />PIUMBINGCONTRACTOR MAILADDRESS <br />CONTRRCT PRICE OF WORK <br />OESCRIBE WORN R�� SOUAPE FOOTAGE <br />CO�SF(J(f G S,^� <br />5n/.'f /i�ri nFu q, <br />CITY <br />7 SF <br />of wti �t, 47o sF � �i7/ !,v ,,,� F:r,sGtc/ <br />PROPOSED USE OF BUILDING <br />IEGRL DESCRIPTION OF PROPEFTY (SHOWN B:IOW OR ATTACH TWO COPIESI <br />�o.� o�ocK �l1L_ oF �t+a—f�l�i 5•nyhit <br />N. za 4��. I �7'Ax Ip s7�R- ooz <br />PRRCELTA%ID.NU A <br />CONSTPUCTIONLOANLENDER.nDDRESS.IELEPMON[NUMBER <br />PHOJECTAUDRE 3 <br />: �9�/ �Uii�iri�l ,��e, <br />PLUMBING <br />N0. TVPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) /% <br />BATHTUB <br />LAVATORY (WASH BASIN) /! <br />G SH6WER <br />KITCHEN SINK 8 DISP / <br />DISHWASHER / <br />v' LAUNDRVTRAY <br />/ CLOTHES WASHER <br />URINAL <br />Q DRINKING FOUNTAIN <br />Q FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />U ROOF DRAINS—RAINLEADERS <br />U S�NK (SERVICE—BAR. ETC.) <br />SUB TOTAL $ <br />FOR OFF!CE USE ONLY: <br />FRONTSETBACk REARSETBACK <br />'^1 1 <br />[.(/ <br />USE ZONE LOT AREA <br />y�- � <br />lYPEOFCON51. NO.OFSTOPIE'. <br />JI[L' V� IlW <br />�468 SfFG <br />OCCUPANCYLO�O <br />REASON /A <br />FIRE SPRINKLERS REO'D <br />No <br />FIRE f.LAFM R�E/OD <br />N '� <br />PLr1NS <br />onTe <br />FEE <br />PMONE STATE LICENSE 1 <br />FND <br />� HEREBY CERTIFY THAT i HAVE READ AND EXAMINED TFIIS <br />APPLICATION AND KNOW THE SAti1E TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEflFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />x V---� ICd� 11-9-93 <br />SIGN�tU�J[ O�iE <br />� <br />FORCED AIR SVSTEMS—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 />METAL FIREPLACE � <br />FIREPLACE INSERT <br />GAS PIPING <br />EXHAUS�FAN //j <br />� �— <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />O�U/A�� I FE ��� I REG�� / <br />vnc Nt sirE FEES <br />' ' YES . . NO BUILDING <br />IXCli�A4CY 1:0 D�ON[LURGCWIS <br />"o`• I pLUMBWG <br />BASEMENT ��� MECHANICAL <br />�l YES �NO -- <br />HEIGNTLIMITAiION A'.101TIONPLPLANCHECK <br />1 n <br />OTH�R �{���IU <br />s-� <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT PUBLIG WCRKS <br />LOCALSALES <br />TAX CODE IS 3105 Tora� <br />0 <br />